Doctor’s Death After Covid Vaccine Is Being Investigated
How scary is that title? It worries me to know that the Coronavirus Pfizer vaccine that was created to save lives, are killing people all around the world.
Dr. Gregory Michael, 56-year-old obstetrician and gynecologist in Miami Beach, received the vaccine at Mount Sinai Medical Center on Dec. 18 and died 16 days later from a brain hemorrhage. Then in Norway, 23 people died after receiving the first dose of Pfizer COVID-19 vaccine, 13 were nursing home patients. Steinar Madden, Medical director said, it is quite clear that these vaccines have very little risk, with a small exception for the frailest patients. Doctors must now carefully consider who should be vaccinated. Although these deaths are low, they are still significantly important because there’s clearly something wrong with the Pfizer vaccine. People need to understand, vaccines are not a ones-size-fits-all.
Agreeing to take the vaccine regardless of which drug company manufactured it, there is a high risk of side effects or possibly dying. When these drug companies, such as Moderna, Pfizer, Johnson & Johnson, Merck, and AstraZeneca (to name of few), created the COVID-19 vaccine they applied for an Emergency Use Authorization (EUA) for distribution.
What is an Emergency Use Authorization (EUA)?
An Emergency Use Authorization (EUA) is a mechanism to facilitate the availability and use of medical countermeasures, including vaccines, during public health emergencies, such as the current COVID-19 pandemic. Under an EUA, FDA may allow the use of unapproved medical products, or unapproved uses of approved medical products in an emergency to diagnose, treat, or prevent serious or life-threatening diseases or conditions when certain statutory criteria have been met, including that there are no adequate, approved, and available alternatives. Taking into consideration input from the FDA, manufacturers decide whether and when to submit an EUA request to FDA.
Once submitted, FDA will evaluate an EUA request and determine whether the relevant statutory criteria are met, taking into account the totality of the scientific evidence about the vaccine that is available to FDA. This emergency use allows drug companies to skip many steps. Steps that would usually include many years of research studies on the efficacy and validity of the vaccine on various different variables. The population of people in the United States consists of so many variables to study. For example:
The effects on people with high blood pressure
The effects on breast cancer, blood cancer, prostate cancer, brain cancer patients and so on.
The effects on diabetics
Psychological and mental disorders
Allergies, pregnancy, infants, elderly, teenagers and so on
That list can go on and on because there are so many underline health conditions to consider when studying the effects on people. I’m not one hundred percent sold on the Emergency Use Authorization for these vaccines because the data is still pending. Everyone that opted-in now to be vaccinated are being studied and monitored closely.
In the months and years to come, that data may be used to adjust or even change the ingredients in the vaccines to address side effects and deaths that people have experienced. The more data on hand, the better the outcome. These first individuals will pave the way for concrete information to be used to create the most effective vaccine. Please be careful because there are fake vaccines and treatments out on the market as well.
Unfortunately, there are people and companies trying to profit from this pandemic by selling unproven and illegally marketed products that make false claims, such as being effective against the coronavirus. These fraudulent products that claim to cure, treat, or prevent COVID-19 haven’t been evaluated by the FDA for safety and effectiveness and might be dangerous to you and your family.
Always consult with your healthcare professionals before taking or thinking of buying any form of drug, tests, treatments, vaccines, or vitamins for the treatment of COVID-19 or any other ailments.
As I discuss in my video How to Treat Heart Failure and Kidney Failure with Diet, one way a diet rich in animal-sourced foods like meat, eggs, and cheese may contributeto heart disease, stroke, and death is through the production of an atherosclerosis-inducing substance called TMAO. With the help of certain gut bacteria, the choline and carnitine found concentrated in animal products can get converted into TMAO. But, wait a second. I thought atherosclerosis, or hardening of the arteries, was about the buildup of cholesterol. Is that not the case?
“Cholesterol is still king,” but TMAO appears to accelerate the process. It seems that TMAO appears to increase the ability of inflammatory cells within the atherosclerotic plaque in the artery walls to bind to bad LDL cholesterol, “which makes the cells more prone to gobble up cholesterol.” So TMAO is just “another piece to the puzzle of how cholesterol causes heart disease.”
What’s more, TMAO doesn’t just appear to worsen atherosclerosis, contributing to strokes and heart attacks. It also contributes to heart and kidney failure. If you look at diabetics after a heart attack, a really high-risk group, nearly all who started out with the most TMAO in their bloodstream went on to develop heart failure within 2,000 days, or about five years. In comparison, only about 20 percent of those starting out with medium TMAO levels in the blood went into heart failure and none at all in the low TMAO group, as you can see at 1:21 in my video.
So, those with heart failure have higher levels of TMAO than controls, and those with worse heart failure have higher levels than those with lesser stage heart disease. If you follow people with heart failure over time, within six years, half of those who started out with the highest TMAO levels were dead. This finding has since been replicated in two other independent populations of heart failure patients.
The question is, why? It’s probably unlikely to just be additional atherosclerosis, since that takes years. For most who die of heart failure, their heart muscle just conks out or there’s a fatal heart rhythm. Maybe TMAO has toxic effects beyond just the accelerated buildup of cholesterol.
What about kidney failure? People with chronic kidney disease are at a particularly “increased risk for the development of cardiovascular disease,” thought to be because of a diverse array of uremic toxins. These are toxins that would normally be filtered out by the kidneys into the urine but may build up in the bloodstream as kidney function declines. When we think of uremic toxins, we usually think of the toxic byproducts of protein putrefying in our gut, which is why specially formulated plant-based diets have been used for decades to treat chronic kidney failure. Indeed, those who eat vegetarian diets form less than half of these uremic toxins.
Those aren’t the only uremic toxins, though. TMAO, which, as we’ve discussed, comes from the breakdown of choline and carnitine found mostly in meat and eggs, may be increasing heart disease risk in kidney patients as well. How? “The cardiovascular implication of TMAO seems to be due to the downregulation of reverse cholesterol transport,” meaning it subverts our own body’s attempts at pulling cholesterol out of our arteries.
And, indeed, the worse our kidney function gets, the higher our TMAO levels rise, and those elevated levels correlate with the amount of plaque clogging up their arteries in their heart. But once the kidney is working again with a transplant, your TMAO levels can drop right back down. So, TMAO was thought to be a kind of biomarker for declining kidney function—until a paper was published from the Framingham Heart Study, which found that “elevated choline and TMAO levels among individuals with normal renal [kidney] function predicted increased risk for incident development of CKD,” chronic kidney disease. This suggests that TMAO is both a biomarker and itself a kidney toxin.
Indeed, when you follow kidney patients over time and assess their freedom from death, those with higher TMAO, even controlling for kidney function, livedsignificantly shorter lives, as you can see at 4:44 in my video. This indicates this is a diet-induced mechanism for progressive kidney scarring and dysfunction, “strongly implying the need to focus preventive efforts on dietary modulation,” but what might that look like? Well, maybe we should reduce “dietary sources of TMAO generation, such as some species of deep-sea fish, eggs, and meat.”
It also depends on what kind of gut bacteria you have. You can feed a vegan a steak, and they still don’t really make any TMAO because they haven’t been fostering the carnitine-eating bacteria. Researchers are hoping, though, that one day, they’ll find a way to replicate “the effects of the vegetarian diet…by selective prebiotic, probiotic, or pharmacologic therapies.”
The research suggests that children clear the infection much faster than adults and may help explain why many don’t become seriously ill.
Children infected with the coronavirus produce weaker antibodies and fewer types of them than adults do, suggesting they clear their infection much faster, according to a new study published Thursday.
Other studies have suggested that an overly strong immune response may be to blame in people who get severely ill or die from Covid-19. A weaker immune response in children may paradoxically indicate that they vanquish the virus before it has had a chance to wreak havoc in the body, and may help explain why children are mostly spared severe symptoms of Covid, the disease caused by the coronavirus. It may also show why they are less likely to spread the virus to others.
“They may be infectious for a shorter time,” said Donna Farber, an immunologist at Columbia University in New York who led the study reported in the journal Nature Immunology.
Having weaker and fewer antibodies does not mean that children would be more at risk of re-infections, other experts said.
“You don’t really need a huge, overly robust immune response to maintain protections over some period of time,” said Deepta Bhattacharya, an immunologist at the University of Arizona in Tucson. “I don’t know that I would be especially worried that kids have a little bit lower antibody response.”
The study looked at children’s antibody levels at a single point in time, and was too small to provide insights into how the levels may vary with age. But it could pose questions for certain antibody tests that may be missing children who have been infected.
Dr. Farber and her colleagues analyzed antibodies to the coronavirus in four groups of patients: 19 adult convalescent plasma donors who had recovered from Covid without being hospitalized; 13 adults hospitalized with acute respiratory distress syndrome resulting from severe Covid; 16 children hospitalized with multi-system inflammatory syndrome, the rare condition affecting some infected children; and 31 infected children who did not have the syndrome. About half of this last group of children had no symptoms at all.
Individuals in each group had antibodies, consistent with other studies showing that the vast majority of people infected with the coronavirus mount a robust immune response.
“This further emphasizes that this viral infection in itself, and the immune response to this virus, is not that different from what we would expect” from any virus, said Petter Brodin, an immunologist at Karolinska Institutet in Stockholm.
But the range of antibodies differed between children and adults. The children made primarily one type of antibody, called IgG, that recognizes the spike protein on the surface of the virus. Adults, by contrast, made several types of antibodies to the spike and other viral proteins, and these antibodies were more powerful at neutralizing the virus.
Children had “less of a protective response, but they also had less of a breadth of an antibody response,” Dr. Farber said. “It’s because those kids are just not getting infected as severely.”
Neither group of children had antibodies to a viral protein called the nucleocapsid, or N, that is entangled with the genetic material of the virus. Because this protein is found within the virus and not on its surface, the immune system would only see it and make antibodies to it if the virus were widely disseminated in the body, she said.
“You don’t really see any of that in the children, and that suggests that there’s really a reduced infection course if these kids are getting infected,” she explained.
The finding could undermine the results from tests designed to pick up antibodies to the N protein of the virus. Many antibody tests, including those made by Abbott and Roche and offered by Quest Diagnostics and LabCorp, are specific to the N antibodies and so may miss children who have successfully cleared the virus. “That’s absolutely an interesting implication of that finding,” Dr. Brodin said.
Lower levels of virus in the body would also explain why children seem generally to transmit the virus less efficiently than adults do. But experts urged some caution in interpreting the results because they represent samples taken from people at a single point in time. Samples from the more severely affected children and adults were collected within 24 to 36 hours of being admitted or intubated for respiratory failure; those from children with mild or no symptoms were banked after medical procedures.
The type of antibodies produced by the body varies over the time course of an infection. This was a limitation of this study because the researchers may have been comparing people at different points in their infection, Dr. Brodin said. “You risk comparing apples and oranges.”
Other experts cautioned that the study was too small to draw conclusions about how the immune response may vary in children of different ages. The children in the study ranged in age from 3 to 18 years, with a median age of 11. But some studies have suggested that teenagers may be just as much at risk from the coronavirus as adults.
“It’s very important to understand what happens in children,” to understand the nature of their illness, but also how they contribute to spread of the virus in the community, said Dr. Maria L. Gennaro, an immunologist at Rutgers University. But “to try and stratify by age, it’s a little bit of a stretch in the analysis,” she said.
The researchers were also not able to explain why children have a more limited antibody response. Having fewer types of antibodies may seem like a bad thing, but “having a ton of antibody isn’t necessarily a marker of a good thing,” said Dr. Bhattacharya. “It usually means that something went wrong early in the response.”
At least one other study has suggested that children have a powerful inborn immune system, intended to combat the many new pathogens they encounter, and that this first line of defense may clear the infection early without needing to rely on later antibodies.
Another possibility is that the children have some protection — in the form of immune cells called memory T cells — from previous encounters with common cold coronaviruses.
“Is it all innate? Or could there actually be some pre-existing memory?” Dr. Bhattacharya said. “I think those are both possible.”
The most common advice on reducing the risk of cervical cancer is centered around a healthy lifestyle, with three major components:
Regular screenings can catch pre-cancerous changes early on, which can be “treated before they have a chance to turn into cancer”. The American Cancer Society reports that cervical cancer is “most frequently diagnosed in women between the ages of 35 and 44”, recommending that women in that age range have both PAP and HPV tests every five years. Women ages 21 to 29 should have a PAP test every three years and tested for HPV only after an abnormal PAP test result. Both tests can be done in a doctor’s office or clinic.
The Pap test (or Pap smear) looks forprecancers,cell changes on the cervix that might become cervical cancer if they are not treated appropriately.
Eating a diet rich in fruits and vegetables helps to reduce the risk of cervical and other cancers. Opt for fruits and vegetables abundant in the following vitamins and nutrients:
Beta-caroteneis an “anti-oxidant that becomes vitamin A in the body” and is what gives orange and yellow veggies their vibrant color. Go forwinter squash, carrotsandsweet potatoes.
Lycopenebelongs to the same carotenoid family as beta-carotene, so again fruits and veggies with lively pink, orange and yellow hues likewatermelon, pink grapefruitandfresh tomatoes.
Folateis a B vitamin that promotes reproductive health and is plentiful inlentils, orangesandromaine lettuce.
Flavonoids“have been shown to exhibit anti-inflammatory, antithrombogenic, antidiabetic, anticancer and neuroprotective activities. Foods such asapples, asparagus, Brussel sprouts, cabbage, onionsandgarlicare abundant in flavonoids.
Physical activity promotes a better quality of life by keeping the body moving, thus strengthening muscles, joints and bones; increasing oxygen and blood flow; and improving mental health. In terms of cancer prevention, the recommendedgeneral physical activity guidelinesare at least 150 minutes of moderate exercise or 75 minutes of vigorous exercise a week.
Dean Foods has seen its profits tumble in recent years as consumers have started drinking less milk
The largest milk producer in the US is filing for bankruptcy. Dean Foods has seen its profits nosedive in recent years – with its CEO saying Americans are drinking less milk. The Dallas-based producer, which is 94-years-old, saw sales fall by seven percent in the first half of 2019, with profits plummeting by 14 percent. Its stock has lost 80 percent in that time.
Reports have cited the skyrocketing popularity of milk alternatives as part of the reason behind Dean Foods’ decline. According to Euromonitor, the global market for milk alternatives is predicted to hit $18 billion this year, up 3.5 percent from 2018 – creating a challenge for dairy producers. “The large and complex U.S. dairy market faces several forces that are influencing future growth and challenging the status quo,” said Euromonitor. “One trend impacting the industry across cheese, milk and yogurt, among other categories, is the competition from plant-based alternatives.
Long before 2016, when fifth-generation dairyman Henry Schwartz decided to shut down Elmhurst Dairy in Jamaica, Queens, he saw the writing on the wall. Dairy consumption was declining and profit margins were increasingly squeezed, making it nearly impossible to turn a profit. Schwartz had kept the company, which his family had run since 1925, chugging along well past its life as a viable business. But the time had come, and in August 2016, he closed the doors of the last functioning dairy plant in New York City limits.
Then, a proverbial door opened. Through business connections, Schwartz was introduced to Cheryl Mitchell — a food scientist who has spent decades of her professional life focused on nondairy milks — those made from nuts, seeds, and grains. Her patents were instrumental in founding the modern-day alternative milk industry, and now she had a new method that she thought could revolutionize the field. Schwartz owned another business, Steuben Foods, that produces aseptic paperboard packaging — the kind used to package things like soups, juices, and the wide array of alternative milks found in the grocery store aisle. All of a sudden, a new path forward appeared.
Schwartz, now 86, no longer gives media interviews. But Elmhurst’s vice president of marketing, Peter Truby, recalled a conference call where Schwartz said, “milk runs through my veins.” The thought of pivoting his family’s long-standing dairy legacy toward a plant-based product was almost unimaginable. But as he got to know the alternative milk industry (and taste Mitchell’s products), he made up his mind. “I remember he came to the plant in November of 2016 and saw the milk coming out for the first time,” Mitchell recalled. “And he said to me, ‘I want to sell it.’”
Today, Elmhurst Dairy is simply Elmhurst — a new company producing milk and creamers made from almonds, cashews, hazelnuts, walnuts, oats, and hemp. Its products, which are remarkably milk-like in creaminess and flavor, are in 6,000 stores across America and shipped all over the country via its website.
“Elmhurst was around as a dairy plant for close to 95 years,” Truby told me. “Now, it has a chance to be around for another 100.”
Schwartz’s path of personal and professional evolution is remarkable. And it is just one of many stories in the modern alternative milk industry, which, according to Truby, currently makes up 13 percent of total sales in the dairy market (and growing). These milks have long been consumed by vegans and lactose-intolerant consumers. And they are increasingly favored by people not looking to fully give up dairy products, but seeking out ways to cut back for ethical, environmental, or health reasons.
Every six months or so, there seems to be a new darling of the industry. For decades, the story was mostly about soy (think Edensoy, Pacific, and Silk) and rice milks. Then came the almond milk craze at the turn of the 21st century, followed closely by coconut milk. More recently, Oatly captured the hearts of the nation’s nondairy lovers, and suddenly grocery stores couldn’t keep the Swedish oat milk company’s products in stock. (Sales of oat milk rose a staggering 425 percent between 2017 and 2018.) There are even milks made from flaxseeds, macadamias, and, advisably or not, bananas and yellow peas. Some scientists have turned their attention instead to lab-produced milks which aim to mimic the microbial structure (and therefore taste and texture) of dairy — but without the cow.
Plant-based milk companies — like Elmhurst in New York, Califia Farms in California, and Good Karma Foods in Colorado — understand that coffee shops are important gateways for introducing new customers to their products. So in addition to analogues for regular cow milk, many companies are also developing special “barista blends” designed to make froth thick and billowy enough to produce latte art and yet, the modern alternative milk industry has more to do with packaging than plants. People have been making beverages from grains, legumes, and seeds for thousands of years. According to the “History of Soymilk” by nondairy disciples William Shurtleff and Akiko Aoyagi, soy milk (doujiang) — always homemade and often served warm for breakfast — was in wide use in China by the mid-17th century, though likely originated earlier. And the creamy fermented rice beverage amazake (the barely alcoholic cousin to sake) has been brewed in Japan since at least the 6th century.
A handful of manufacturers in China, Japan, and the United States began bottling and selling plant-based (primarily soy) milks in the early 20th century. But it wasn’t until the late 1960s that aseptic paperboard packaging was created, allowing companies to offer shelf-stable products that could last without refrigeration for six months or longer. This development was a boon for the fledgling alternative milk industry because it took the pressure off of immediately selling these products — which most American consumers were either unfamiliar with or skeptical about — before they spoiled.
Mitchell has been there since nearly the beginning. In the 1970s, a health food advocate and restaurateur named Robert Nissenbaum approached Mitchell for advice. He had been serving housemade amazake to customers at his Sunshine Inn restaurant in St. Louis, Missouri, and was receiving enthusiastic feedback. As Mitchell recalls, “He came to us and said, ‘I’d like to get it in a package. Can we manufacture it so it can be on the regular shelf instead of the refrigerator case?’” The short answer turned out to be yes, and with Mitchell’s expertise, Nissenbaum went on to found industry giants Rice Dream and Imagine Foods.
The success of these early companies helped to bring alternative milks to the mainstream, or at least closer to it. But Mitchell was not satisfied. The dominant process for “milking” the rice, which typically began with grinding the grain to make a flour or paste, removed a lot of its inherent nutritive aspects — things like fiber, protein, and antioxidant oils. The result was a milk that was thin (“It did not have the richness or milk-like opacity that customers expected,” Mitchell said) and not particularly nutrient-dense.
To compensate, they added many of these qualities back in, using safflower oil, carrageenan, and calcium carbonate. “I still feel guilty about it,” Mitchell said. The technique worked so well for Rice Dream that other companies began to mimic their methods. Consumers went crazy for these “healthy” alternatives to dairy, but there was ultimately no nutritional value. As Mitchell put it, “You are basically paying for water, gums, and a couple of nuts or grains.”
Over the last two decades, Mitchell paid a form of professional penance by devoting her work to maximizing the nutrient value of nondairy milks.
“I spent a lot of my own money on research because no one else was doing it,” she said. Her efforts paid off in a new patent called HydroRelease, which uses very high water pressure to slough off layers of whatever ingredient is being milked. Some plant based milks, particularly almond milk, have gotten a bad reputation for their environmentally unfriendly water usage. Mitchell’s technology, however, mitigates this impact by recycling the water used during HydroRelease. “Once we start spraying, it is the same water over and over again, so the milk gets more and more concentrated.”
The process also “releases each of the macro- and micro-ingredients — the natural lecithins, the oils, the binders,” Mitchell said. These components can then be recombined and emulsified into a creamy, nutritious, functional, and frothable milk. There is no need to add gums or anything extra (many of Elmhurst’s products contain only two ingredients, one of which is water) — it is all there in the plants.
Of course, with so much competition crowding the field, the bottom line for Elmhurst — or any nondairy milk — is, how do they taste? Flavor has been a concern of the industry for years. In the 1960s, write Shurtleff and Aoyagi, Cornell University scientists isolated the enzyme lipoxygenase as “responsible for the ‘beany’ flavor in soy milk,” and developed processes to help remove it.
Still, during the two years I spent as a vegan in college during the early 2000s, I tried and failed to convince myself that I — a born-and-bred, dairy-guzzling Midwesterner — really enjoyed Silk and Edensoy with cereal, or leaving curdled flecks on the surface of my coffee. I never worked my way up to drinking straight glasses of the stuff. It definitely wasn’t milk and, more importantly, it wasn’t very good.
But while nothing quite compares in flavor or texture to cow dairy, the field of options has improved tremendously. Today, my family’s fridge, like many other fridges, is multi-milked. Despite my lifelong love affair with dairy, my kids’ digestive systems seem to tolerate it less well. So there’s dairy half-and-half for coffee, and a rotation of cashew and oat milks (often from Elmhurst) for cereal, smoothies, and cooking. And I have come to enjoy the nutty, chai-like quality of So Delicious’ cashew milk ice cream nearly as much as regular dairy vanilla.
Mitchell has never been fully vegan herself. (One of her daughters is, however, and her other daughter eats meat but cannot handle dairy.) But despite being a flexitarian, she, like Schwartz, believes the future lies in plant-based milks — particularly ones that hold on to their natural nutritive qualities. And she is excited by their growing epicurean potential.
As it turns out, when the milks retain their proteins and fiber, they just work better in culinary applications. “You can make an amazingly convincing nondairy bechamel because the building blocks are there,” Mitchell said. “There is so much more we can develop using these ingredients. I’m happy to provide the tools to take us to the next generation.”
Colorectal cancer is typically considered a disease of aging — most new cases are diagnosed in people over age 50. But even as the rates decrease in older adults, scientists have documented a worrisome trend in the opposite direction among patients in their 20s and 30s. Now, data from national cancer registries in Canada add to the evidence that colorectal cancer rates are rising in younger adults. The increases may even be accelerating.
“We thought that this trend would slow down or level off after people first noticed it a few years ago,” said Darren Brenner, a molecular cancer epidemiologist at the University of Calgary and lead author of the new study, published on Wednesday in the journal JAMA Network Open. “But every year we keep seeing the increase in colorectal cancer among young people, and it is very alarming.” Between 2006 and 2015, the last year for which figures are available, colorectal cancer rates increased by 3.47 percent among Canadian men under age 50, Dr. Brenner and his colleagues found. And from 2010 to 2015, rates increased by 4.45 percent among women under age 50. Yet colon and rectal cancers have been steadily decreasing among older adults in Canada because of increased awareness of the disease and widespread use of screening tests like colonoscopies, which can identify and remove colon polyps before cancer develops.
The pattern is quite similar to that observed by researchers in the United States. Researchers at the University of Texas at Austin reported last week that the proportion of newly diagnosed colorectal patients under age 50 rose from 10 percent in 2004 to 12.2 percent in 2015. Younger patients were also likely to have advanced cases more often than older patients. Over all, the risk of colorectal cancer is still much lower in younger adults than in older ones. But the continuing uptick means that millennials will most likely carry an elevated risk as they get older.
“They’ll carry that risk with them, so that they have a much higher risk than their parents when they reach their 50s and 60s,” said Rebecca Siegel, an epidemiologist at the American Cancer Society. Recent lifestyle changes may be partly to blame. Obesity and sedentary lifestyles, for example, are linked to colorectal cancer, as are poor diets low in fiber. Patients with chronic inflammation or Type 2 diabetes have also been found to be at increased risk for the disease. But experts are not entirely convinced these are the only factors at work. Trends in obesity among people of different ethnic and racial backgrounds don’t always correspond to an increase in colorectal cancer, according to Ms. Siegel.
Some studies have found that obesity brings increased risk of colon cancer, while others, including the new JAMA research, have found a greater increase in cancers of the rectum. Until there is more research into what is causing the increase in colorectal cancers, Ms. Siegel encourages younger people to be more proactive about identifying signs early on. Persistent constipation, cramps, bloating, blood in stool, unexplained weight loss and fatigue can all be symptoms. Younger people and their doctors often overlook the warning signs because “cancer is not on their radar,” Ms. Siegel said.
The American Cancer Society now recommends screening average-risk individuals for colorectal cancer starting at age 45. Researchers in Canada also are considering changes to screening recommendations. But these revisions are unlikely to help prevent cancers among patients who are even younger. “We need to understand why this trend is occurring in young people in order to prevent it,” Dr. Brenner said.
For generations, urinary tract infections, one of the world’s most common ailments, have been easily and quickly cured with a simple course of antibiotics. But there is growing evidence that the infections, which afflict millions of Americans a year, mostly women, are increasingly resistant to these medicines, turning a once-routine diagnosis into one that is leading to more hospitalizations, graver illnesses and prolonged discomfort from the excruciating burning sensation that the infection brings.
The New York City Department of Health has become so concerned about drug-resistant U.T.I.s, as they are widely known, that it introduced a new mobile phone app this month that gives doctors and nurses access to a list of strains of urinary tract infections and which drugs they are resistant to. The department’s research found that a third of uncomplicated urinary tract infections caused by E. coli — the most common type now — were resistant to Bactrim, one of the most widely used drugs, and at least one fifth of them were resistant to five other common treatments. “This is crazy. This is shocking,” said Lance Price, director of the Antibiotic Resistance Action Center at George Washington University, who was not involved in the research.
The drug ampicillin, once a mainstay for treating the infections, has been abandoned as a gold standard because multiple strains of U.T.I.s are resistant to it. Some urinary tract infections now require treatment with heavy-duty intravenous antibiotics. Researchers last year reported in astudythat a third of all U.T.I.s in Britain are resistant to “key antibiotics.” Certainly, the day-to-day experience of having a U.T.I. is growing less routine for many women. Carolina Barcelos, 38, a postdoctoral researcher in Berkeley, Calif., said she had several U.T.I.s as a teenager, all successfully treated with Bactrim. When she got one in February, her doctor also prescribed Bactrim, but this time it didn’t work.
Four days later, she returned and got a new prescription, for a drug called nitrofurantoin. It didn’t work either. Her pain worsened, and several days later, there was blood in her urine. Her doctor prescribed a third drug, ciproflaxacin, the last of the three major front-line medicines, and cultured her urine. The culture showed her infection was susceptible to the new drug, but not the other two. “Next time,” Dr. Barcelos said, “I’m going to ask them to do a culture right away. For eight days I was taking antibiotics that weren’t working for me.” Usually, it is people with weakened immune systems or chronic medical conditions who are most vulnerable to drug-resistant infections, but U.T.I.s have a dubious distinction: They are the single biggest risk to healthy people from drug-resistant germs.
Resistance to antibiotics has become one of the world’s most pressing health issues. Overuse of the drugs in humans and livestock has caused germs to develop defenses to survive, rendering a growing number of medicines ineffective in treating a wide range of illnesses — a phenomenon that is playing out worldwide with U.T.I.s.
The World Health Organization, while noting that data on urinary tract infections and drug resistance is “scarce,” said the fact the infections were so common strongly suggested that increasing resistance would lead to more severe illnesses and fatalities. The solution, researchers and clinicians say, includes a continued push for more judicious use of antibiotics worldwide. But more immediately, a partial solution would be the development of quick, cheap diagnostic tools that would allow an instant urine culture so that a doctor could prescribe the right drug for U.T.I.s.
But whether to wait the several days it usually takes to get lab results before prescribing presents a tough dilemma for doctors and patients, who frequently are desperate for relief. Plus, depending on a person’s insurance, getting a culture can be expensive. Generally doctors still do not order a urine culture before prescribing an antibiotic.
“In the old days, the list of antibiotic options was short but by and large they would all work,” said Dr. James Johnson, an infectious disease professor and leading researcher on urinary tract infections at the University of Minnesota. Some women have U.T.I.s that the body fights off on its own without using antibiotics, while other women may have a different low-level ailment that feels like a U.T.I., but isn’t. The safest course is to see a doctor and make an informed decision that includes a judicious determination of whether antibiotics are warranted. The science does not support the efficacy of some popular remedies like cranberry juice or cranberry pills.
Officials from the federal Centers for Disease Control and Prevention said that U.T.I.s acquired by otherwise healthy people were a growing concern and one poorly studied. They are not tracked nationally. In older people, urinary tract infections can be deadly, but tracking in the United States is so weak that there are no reliable estimates on the numbers of deaths related to the infections. The C.D.C. published an estimate of 13,000 per year, but that figure comes froma paper looking at 2002 dataand refers only to U.T.I.s acquired in hospitals. Dr. Clifford McDonald, associate director for science in the division of health care quality promotion at the C.D.C., said the government planned to expand its research.
“If we don’t do something soon,” Dr. McDonald said, “it’s going to push all our treatments to more advanced antibiotics that finally put a lot of pressure on the last-line treatments.”
What makes these infections so dangerous, and commonplace, is human anatomy. In women, the urethra — the gateway to the urinary tract — is in proximity to the rectum. This can lead to easy transfer of bacteria in fecal residue that otherwise resides harmlessly in the gut.
In reproductive years, women are 50 times for likely than men to have a urinary tract infection; later in life, the ratio drops to 2 to 1, as men wind up having surgical procedures on their prostate, or catheters, that more easily expose their urinary tracts to infection.
There are multiple germs that cause U.T.I.s, and their resistance levels to drugs vary both by strain and by where a patient lives. By far the most common cause of U.T.I.s today is E. coli, and, in general, those infections have seensharp rises in resistanceto gold standard treatments over the past decade and a half.
New research shows that one crucial path of transfer of germs that cause U.T.I.s is food, most often poultry. The consumed poultry winds up in a person’s gut and can get transferred through fecal residue to the urethra.
A study published last year by the American Society of Microbiology, funded partly by the C.D.C., found 12 strains of E. coli in poultry that matched widely circulating urinary tract infection strains. One of the study’s authors, Dr. Lee Riley, a professor of epidemiology and infectious diseases at the University of California, Berkeley, said he was working on a C.D.C.-funded project to determine whether the urinary tract infection needs to be classified and reported as a food-borne illness.
Dr. Brad Frazee, an emergency room doctor at Highland Hospital in Oakland, Calif., has been a co-author ofresearchthat adds another troubling wrinkle: Increasingly, E. coli is proving resistant not just to individual antibiotics, but also to a broad group of drugs known as beta-lactam antibiotics. These drugs share a way of attacking infection, and when a germ develops resistance to this method of attack, it eliminates several key treatment options all at once.
Recently, a woman carrying such resistance showed up at Dr. Frazee’s hospital, he said. She wound up with pyelonephritis, an infection in the kidney, and had to be treated in the hospital intravenously with a drug called ertapenem that can cost $1,000 a dose. A study found that around 5 percent of U.T.I.s at the hospital carried this resistance.
Doctors are now confronting cases of resistant urinary tract infections in their practices. Dr. Eva Raphael, a primary care physician in San Francisco, recently received notice that one of her patients, a healthy woman in her mid-30s, was back in the emergency room with another U.T.I. that was resistant to multiple antibiotics.
One of her prior U.T.I.s had failed to respond to two commonly used treatments and had spread to her kidney, requiring hospitalization to receive intravenous antibiotics. This time Dr. Raphael consulted with infectious disease specialists. “It can be quite dangerous in this age where there is more and more resistance,” she said, noting that without effective treatment the infection can get into the blood. “It can be fatal.”
A study published in the journalJAMA Internal Medicineon Monday suggests that the link is strongest for certain classes of anticholinergic drugs — particularly antidepressants such as paroxetine or amitriptyline, bladder antimuscarinics such as oxybutynin or tolterodine, antipsychotics such as chlorpromazine or olanzapine and antiepileptic drugs such as oxcarbazepine or carbamazepine.
Researchers wrote in the study that “there was nearly a 50% increased odds of dementia” associated with a total anticholinergic exposure of more than 1,095 daily doses within a 10-year period, which is equivalent to an older adult taking a stronganticholinergic medication daily for at least three years, compared with no exposure.
“The study is important because it strengthens a growing body of evidence showing that strong anticholinergic drugs have long term associations with dementia risk,” said Carol Coupland, professor of medical statistics in primary care at theUniversity of Nottinghamin the United Kingdom and first author of the study.
“It also highlights which types of anticholinergic drugs have the strongest associations. This is important information for physicians to know when considering whether to prescribe these drugs,” she said, adding “this is an observational study so no firm conclusions can be drawn about whether these anticholinergic drugs cause dementia.”
She said that people taking these medications are advised not to stop them without consulting with their doctor first, as that could be harmful. The study involved analyzing data on 284,343 adults in the United Kingdom, aged 55 and older, between 2004 and 2016. The data came fromQResearch, a large database of anonymized health records.
The researchers identified each adult’s anticholinergic exposure based on details of their prescriptions. The researchers found the most frequently prescribed anticholinergic drugs were antidepressants, drugs to treat vertigo, motion sickness or vomiting and bladder antimuscarinic drugs, such as to treat overactive bladder. The researchers also took a close look at who was diagnosed with dementia and found that 58,769 of the patients had a dementia diagnosis.
The researchers found no significant increases in dementia risk associated with antihistamines, skeletal muscle relaxants, gastrointestinal antispasmodics, antiarrhythmics, or antimuscarinic bronchodilators, according to the data, but associations were found among other classes of anticholinergic drugs. The researchers found that the odds of dementia increased from 1.06 among those with the lowest anticholinergic exposure to 1.49 among those with the highest exposure, compared with having no prescriptions for anticholinergic drugs.
The study had some limitations, including that some patients may not have taken their prescribed medication as directed, so anticholinergic exposure levels could have been misclassified. The researchers found only an association between anticholinergic drugs and dementia risk, not a causal relationship.
“However, if this association is causal, the population-attributable fractions indicate that around 10% of dementia diagnoses are attributable to anticholinergic drug exposure, which would equate, for example, to around 20,000 of the 209,600 new cases of dementia per year in the United Kingdom,” the researchers wrote in the study.Since the study shows only an association, more research is needed to “clarify whether anticholinergic medications truly represent a reversible risk factor” for dementia, wrote expertsNoll Campbell,Richard HoldenandDr. Malaz Boustaniin an editorial that published alongside the new study in JAMA Internal Medicine.
“Additionally, deprescribing trials can evaluate potential harms of stopping anticholinergic medications, such as worsening symptoms of depression, incontinence, or pain, as well as the potential unintended increase in acute health care utilization,” Campbell, Holden and Boustani wrote in the editorial.”With little evidence of causation, the next steps for research on anticholinergic medications in older adults must improve knowledge of the effect of deprescribing interventions on cognitive outcomes and important safety outcomes such as symptom control, quality of life, and health care utilization,” they wrote. “We propose deprescribing research as a high priority.”
It has been well known that anticholinergic agents and confusion or memory issues are linked, but the new study investigated this association over a long period of time, said Dr. Douglas Scharre, director of the division of cognitive neurology at theOhio State University Wexner Medical Centerin Columbus, who was not involved in the study.
He encouraged any patients who might have questions about this association to talk to their physicians. “I spend a lot of my time in the memory disorder clinic seeing geriatric patients and taking people off medications, mostly ones that have anticholinergic properties, and many times there can be another drug out there that has less anticholinergic impact or is non-anticholinergic that may work,” Scharre said.
“Some of the medications that they list in the study may be quite critical and important and are well worth the person taking for their seizures or their psychosis, and so it’s a risk-benefit discussion,” he added. “So have a conversation with your doctor.”
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