Thursday, August 30, 2012

Taking a Knife to your Baby's Penis

Reports like this reinforce my belief that many ancient traditional or religious practices are science-based and good for your health.  Here are some benefits of male circumcision:
- Reduced transmission of some sexually transmitted infections, including HIV
- Reduced transmission of HPV viruses that cause cervical cancer in women
- Prevention of urinary tract infections
- Prevention of penile cancer
None of these known benefits applies to the misnamed female "circumcision", which does not involve removal of foreskin, but resection of the clitoris entirely...but that's a whole different post...
Peace & health,
Dr. Safiyya

Evidence Favors Male Circumcision, But Parents Still Must Choose, Says AAP

Study: Increase in Neonatal Circumcisions Could Save Billions

By Matt Brown

Posted: 8/28/2012, 12:25 p.m. -- According to the American Academy of Pediatrics (AAP), the latest evidence shows (4-page PDF; About PDFs) the benefits of newborn male circumcision outweigh the risks.
Doctor circumcising newborn
The AAP, in an updated policy statement published Aug. 27 in Pediatrics, said that a multidisciplinary panel evaluated the evidence and determined that circumcision's benefits -- prevention of urinary tract infections, penile cancer and transmission of some sexually transmitted infections, including HIV -- justify access to the procedure (i.e., health insurance coverage) for families who choose it.

Previously, the AAP did not recommend for or against the procedure, citing insufficient evidence to make a determination in its earlier policy, which was published in 1999 and reaffirmed in 2005.

According to Susan Blank, M.D., chair of the AAP's statement and technical report task force, recent scientific research shows clearer health benefits to the procedure than had been demonstrated previously, but the choice still rests with parents.

"Ultimately, this is a decision that parents will have to make," Blank said in an AAP press release. "Parents are entitled to medically accurate and nonbiased information about circumcision, and they should weigh this medical information in the context of their own religious, ethical and cultural beliefs."

The AAFP Commission on Health of the Public and Science's Subcommittee on Clinical Practice Guidelines will review the update, as well as the accompanying technical report, in the coming months. Family physician Lesley Atwood, M.D., served as the AAFP's liaison to the AAP task force.

The Academy's position paper on neonatal circumcision, which was updated in 2007, does not recommend for or against the procedure and states that although the literature available at the time was "conflicting or inconclusive," the decision whether or not to circumcise generally comes down to nonmedical preferences. Therefore, physicians should discuss the potential harms and benefits of newborn male circumcision with all parents or legal guardians considering the procedure.

The AAP's shift in position may strengthen circumcision proponents' call to reverse the steadily declining rates of infant male circumcision in the United States. An Aug. 20 report in the Archives of Pediatrics & Adolescent Medicine indicates that circumcision rates have declined from 79 percent to 55 percent in the past two decades -- a drop that has coincided with reduced insurance coverage for the procedure.

Eighteen states currently do not provide Medicaid coverage for infant circumcision, and private third-party payers also are decreasing coverage, the study notes.

According to a release that accompanied the study, if this trend continues and rates decline to European levels, net present value of additional health care expenditures in the United States would exceed $4.4 billion in the next 10 annual birth cohorts.

The study, which indicates that the added expenses stem from higher rates of sexually transmitted infections and related cancers among uncircumcised men and their female partners, estimates that the current decline already has cost the United States more than $2 billion.

"Our economic evidence is backing up what our medical evidence has already shown to be perfectly clear," said Aaron Tobian, M.D., Ph.D., senior study investigator and health epidemiologist and pathologist at the Johns Hopkins University School of Medicine in Baltimore. "There are health benefits to infant male circumcision in guarding against illness and disease, and declining male circumcision rates come at a severe price, not just in human suffering, but in billions of health care dollars as well."

Thursday, August 16, 2012

Controlling your Genetic Destiny

Unlocking the Potential of your DNA

  A few months ago I read an interesting article in the publication my med school alma mater sends outlining important advances in the field of epigenetics.  Most of us have heard about the Human Genome Project and perhaps understand the basic idea of how DNA works.  You know that DNA makes us who we are.  But have you ever wondered how all the cells in your body carry the same DNA as the first, but vary widely depending on location and function?  For instance, the cells in your stomach are pumping out acid strong enough to eat through nails, yet the cells in your eyeball have enough intelligence not to do that.  How is it that when a liver cell divides and makes a copy of your entire genome, it remembers that it is still a liver, not a lung?  Well the science that explains these observations is called epigenetics, literally “above the genes”.
This is the science of turning genes on and off on your DNA.  A good analogy I've read is that DNA is what is written in ink, your epigenome is what is written in pencil.  It determines the appearance, fate and function of the various cells, and ultimately the organism as a whole.  The bad news and the good news about this epigenome is that it is very responsive to the conditions in and around your body. 
It has been determined that the environmental conditions that one is subjected to are just as important, if not more important, than what is coded on the DNA itself.  Thus identical twins, literally clones of one another, can be so different in terms of the way that their genes are actually working, that one dies young of cancer, while the other enjoys a long, healthy life.  The difference between the two being factors such as diet, drug and toxin exposure, smoking, stress, physical activity, and any number of other human experiences.  Even more fascinating, these experiences and their effect on how the DNA is expressed can be passed on from one generation to the next. 
Furthermore, experiments have shown that you can reverse a harmful pattern of DNA expression in an animal’s offspring, by changing something as simple as the foods being consumed.  Check out this video from Nova describing how this was done with mice being fed methyl rich foods (Hint: navy beans, milk, & whole wheat bread are packed with methyl rich nutrients...)

There was even an article in Time magazine in January 2010 describing an observational study in Sweden, where it was found that boys who experienced just one abundant harvest and enjoyed just one gluttonous winter, produced sons and grandsons whose lives were curtailed.  When they controlled for certain socioeconomic factors, they found that this difference in lifespan was a whopping 32 years!  Similar lifespan reductions were observed in females.  As a physician who is all too aware of the overwhelmingly unhealthy diet of the men, women and children in our communities, this literally brought tears to my eyes.  If a single winter of a child overeating sentenced their grandchildren to an early death, where does that leave us? 
On the bright side, it has been shown that mental function in animals can be improved from one generation to the next with exposure to memory problems, toys, exercise, & extra attention.  So learn, live, love, laugh...and move!

Who knitted our DNA?

As I've spent the past month fasting for Ramadan, I have reflected on the
possibility that all of the prayers, fasting, restriction and other ways of devotion shared by many faiths around the world are a divine way of guiding us towards a heavenly state of body and mind while we live.  After all, if we were made in the image and likeness of God, maybe we share some of His DNA.  Following the commandments of the Creator might be doing something to our DNA that makes us more like Him.

I've never smoked, but I'm sure there were many things I could have done better...
 Perhaps that's a leap, but I believe there are reasons behind many religious practices that are based in science and lead to the spiritual outcome many of us are seeking.  In any case, it's good to know we can control our genetic destiny to a degree.  It's hard to avoid every environmental insult, but knowing the choices we make have a lasting effect has left me more motivated to acquire & maintain healthier habits.  I only wish I'd known this before I had my children.  I might have been even more careful about the epigenes I was passing down!

Peace & health,

Dr. Safiyya