Flossing Without Flossing?
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Flossing Without Flossing?
You almost certainly brush your teeth. You might use mouthwash. A lot of people floss for three weeks at a time, often in January.
There are a lot of options for oral hygiene; variations of the above, and many alternatives too. This is a big topic, so rather than try to squeeze it all in one, this will be a several-part series.
The first part was: Toothpastes & Mouthwashes: Which Help And Which Harm?
How important is flossing?
Interdental cleaning is indeed pretty important, even though it may not have the heart health benefits that have been widely advertised:
However! The health of our gums is very important in and of itself, especially as we get older:
Flossing Is Associated with Improved Oral Health in Older Adults
But! It helps to avoid periodontal (e.g. gum) disease, not dental caries:
Flossing for the management of periodontal diseases and dental caries in adults
And! Most certainly it can help avoid a stack of other diseases:
Interdental Cleaning Is Associated with Decreased Oral Disease Prevalence
…so in short, if you’d like to have happy healthy teeth and gums, flossing is an important adjunct, and/but not a one-stop panacea.
Is it better to floss before or after brushing?
As you prefer. A team of scientists led by Dr. Claudia Silva studied this, and found that there was “no statistical difference between brush-floss and floss-brush”:
Flossing is tedious. How do we floss without flossing?
This is (mostly) about water-flossing! Which does for old-style floss what sonic toothbrushes to for old-style manual toothbrushes.
If you’re unfamiliar, it means using a device that basically power-washes your teeth, but with a very narrow high-pressure jet of water.
Do they work? Yes:
As for how it stacks up against traditional flossing, Liang et al. found:
❝In our previous single-outcome analysis, we concluded that interdental brushes and water jet devices rank highest for reducing gingival inflammation while toothpick and flossing rank last.
In this multioutcome Bayesian network meta-analysis with equal weight on gingival inflammation and bleeding-on-probing, the surface under the cumulative ranking curve was 0.87 for water jet devices and 0.85 for interdental brushes.
Water jet devices and interdental brushes remained the two best devices across different sets of weightings for the gingival inflammation and bleeding-on-probing. ❞
~ Journal of Evidence-Based Dental Practice
You may be wondering how safe it is if you have had dental work done, and, it appears to be quite safe, for example:
BDJ | Water-jet flossing: effect on composites
Want to try water-flossing?
Here are some examples on Amazon:
- Waterpik Complete Care 9.0 ← example of a top-end water-flossing device
- Philips Sonicare Power Flosser 3000 ← top-tier not-Waterpik-brand device
- INSMART Cordless Water Dental Flosser ← very low price and still average 4.5 star reviews, so in our opinion, a fine first choice
Bonus: if you haven’t tried interdental brushes, here’s an example for that
Enjoy!
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Drug companies pay doctors over A$11 million a year for travel and education. Here’s which specialties received the most
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Drug companies are paying Australian doctors millions of dollars a year to fly to overseas conferences and meetings, give talks to other doctors, and to serve on advisory boards, our research shows.
Our team analysed reports from major drug companies, in the first comprehensive analysis of its kind. We found drug companies paid more than A$33 million to doctors in the three years from late 2019 to late 2022 for these consultancies and expenses.
We know this underestimates how much drug companies pay doctors as it leaves out the most common gift – food and drink – which drug companies in Australia do not declare.
Due to COVID restrictions, the timescale we looked at included periods where doctors were likely to be travelling less and attending fewer in-person medical conferences. So we suspect current levels of drug company funding to be even higher, especially for travel.
Monster Ztudio/Shutterstock What we did and what we found
Since 2019, Medicines Australia, the trade association of the brand-name pharmaceutical industry, has published a centralised database of payments made to individual health professionals. This is the first comprehensive analysis of this database.
We downloaded the data and matched doctors’ names with listings with the Australian Health Practitioner Regulation Agency (Ahpra). We then looked at how many doctors per medical specialty received industry payments and how much companies paid to each specialty.
We found more than two-thirds of rheumatologists received industry payments. Rheumatologists often prescribe expensive new biologic drugs that suppress the immune system. These drugs are responsible for a substantial proportion of drug costs on the Pharmaceutical Benefits Scheme (PBS).
The specialists who received the most funding as a group were cancer doctors (oncology/haematology specialists). They received over $6 million in payments.
This is unsurprising given recently approved, expensive new cancer drugs. Some of these drugs are wonderful treatment advances; others offer minimal improvement in survival or quality of life.
A 2023 study found doctors receiving industry payments were more likely to prescribe cancer treatments of low clinical value.
Our analysis found some doctors with many small payments of a few hundred dollars. There were also instances of large individual payments.
Why does all this matter?
Doctors usually believe drug company promotion does not affect them. But research tells a different story. Industry payments can affect both doctors’ own prescribing decisions and those of their colleagues.
A US study of meals provided to doctors – on average costing less than US$20 – found the more meals a doctor received, the more of the promoted drug they prescribed.
Pizza anyone? Even providing a cheap meal can influence prescribing. El Nariz/Shutterstock Another study found the more meals a doctor received from manufacturers of opioids (a class of strong painkillers), the more opioids they prescribed. Overprescribing played a key role in the opioid crisis in North America.
Overall, a substantial body of research shows industry funding affects prescribing, including for drugs that are not a first choice because of poor effectiveness, safety or cost-effectiveness.
Then there are doctors who act as “key opinion leaders” for companies. These include paid consultants who give talks to other doctors. An ex-industry employee who recruited doctors for such roles said:
Key opinion leaders were salespeople for us, and we would routinely measure the return on our investment, by tracking prescriptions before and after their presentations […] If that speaker didn’t make the impact the company was looking for, then you wouldn’t invite them back.
We know about payments to US doctors
The best available evidence on the effects of pharmaceutical industry funding on prescribing comes from the US government-run program called Open Payments.
Since 2013, all drug and device companies must report all payments over US$10 in value in any single year. Payment reports are linked to the promoted products, which allows researchers to compare doctors’ payments with their prescribing patterns.
Analysis of this data, which involves hundreds of thousands of doctors, has indisputably shown promotional payments affect prescribing.
Medical students need to know about this. LightField Studios/Shutterstock US research also shows that doctors who had studied at medical schools that banned students receiving payments and gifts from drug companies were less likely to prescribe newer and more expensive drugs with limited evidence of benefit over existing drugs.
In general, Australian medical faculties have weak or no restrictions on medical students seeing pharmaceutical sales representatives, receiving gifts, or attending industry-sponsored events during their clinical training. They also have no restrictions on academic staff holding consultancies with manufacturers whose products they feature in their teaching.
So a first step to prevent undue pharmaceutical industry influence on prescribing decisions is to shelter medical students from this influence by having stronger conflict-of-interest policies, such as those mentioned above.
A second is better guidance for individual doctors from professional organisations and regulators on the types of funding that is and is not acceptable. We believe no doctor actively involved in patient care should accept payments from a drug company for talks, international travel or consultancies.
Third, if Medicines Australia is serious about transparency, it should require companies to list all payments – including those for food and drink – and to link health professionals’ names to their Ahpra registration numbers. This is similar to the reporting standard pharmaceutical companies follow in the US and would allow a more complete and clearer picture of what’s happening in Australia.
Patients trust doctors to choose the best available treatments to meet their health needs, based on scientific evidence of safety and effectiveness. They don’t expect marketing to influence that choice.
Barbara Mintzes, Professor, School of Pharmacy and Charles Perkins Centre, University of Sydney and Malcolm Forbes, Consultant psychiatrist and PhD candidate, Deakin University
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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A new emergency procedure for cardiac arrests aims to save more lives – here’s how it works
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As of January this year, Aotearoa New Zealand became just the second country (after Canada) to adopt a groundbreaking new procedure for patients experiencing cardiac arrest.
Known as “double sequential external defibrillation” (DSED), it will change initial emergency response strategies and potentially improve survival rates for some patients.
Surviving cardiac arrest hinges crucially on effective resuscitation. When the heart is working normally, electrical pulses travel through its muscular walls creating regular, co-ordinated contractions.
But if normal electrical rhythms are disrupted, heartbeats can become unco-ordinated and ineffective, or cease entirely, leading to cardiac arrest.
Defibrillation is a cornerstone resuscitation method. It gives the heart a powerful electric shock to terminate the abnormal electrical activity. This allows the heart to re-establish its regular rhythm.
Its success hinges on the underlying dysfunctional heart rhythm and the proper positioning of the defibrillation pads that deliver the shock. The new procedure will provide a second option when standard positioning is not effective.
Using two defibrillators
During standard defibrillation, one pad is placed on the right side of the chest just below the collarbone. A second pad is placed below the left armpit. Shocks are given every two minutes.
Early defibrillation can dramatically improve the likelihood of surviving a cardiac arrest. However, around 20% of patients whose cardiac arrest is caused by “ventricular fibrillation” or “pulseless ventricular tachycardia” do not respond to the standard defibrillation approach. Both conditions are characterised by abnormal activity in the heart ventricles.
DSED is a novel method that provides rapid sequential shocks to the heart using two defibrillators. The pads are attached in two different locations: one on the front and side of the chest, the other on the front and back.
A single operator activates the defibrillators in sequence, with one hand moving from the first to the second. According to a recent randomised trial in Canada, this approach could more than double the chances of survival for patients with ventricular fibrillation or pulseless ventricular tachycardia who are not responding to standard shocks.
The second shock is thought to improve the chances of eliminating persistent abnormal electrical activity. It delivers more total energy to the heart, travelling along a different pathway closer to the heart’s left ventricle.
Evidence of success
New Zealand ambulance data from 2020 to 2023 identified about 1,390 people who could potentially benefit from novel defibrillation methods. This group has a current survival rate of only 14%.
Recognising the potential for DSED to dramatically improve survival for these patients, the National Ambulance Sector Clinical Working Group updated the clinical procedures and guidelines for emergency medical services personnel.
The guidelines now specify that if ventricular fibrillation or pulseless ventricular tachycardia persist after two shocks with standard defibrillation, the DSED method should be administered. Two defibrillators need to be available, and staff must be trained in the new approach.
Though the existing evidence for DSED is compelling, until recently it was based on theory and a small number of potentially biased observational studies. The Canadian trial was the first to directly compare DSED to standard treatment.
From a total of 261 patients, 30.4% treated with this strategy survived, compared to 13.3% when standard resuscitation protocols were followed.
The design of the trial minimised the risk of other factors confounding results. It provides confidence that survival improvements were due to the defibrillation approach and not regional differences in resources and training.
The study also corroborates and builds on existing theoretical and clinical scientific evidence. As the trial was stopped early due to the COVID-19 pandemic, however, the researchers could recruit fewer than half of the numbers planned for the study.
Despite these and other limitations, the international group of experts that advises on best practice for resuscitation updated its recommendations in 2023 in response to the trial results. It suggested (with caution) that emergency medical services consider DSED for patients with ventricular fibrillation or pulseless ventricular tachycardia who are not responding to standard treatment.
Training and implementation
Although the evidence is still emerging, implementation of DSED by emergency services in New Zealand has implications beyond the care of patients nationally. It is also a key step in advancing knowledge about optimal resuscitation strategies globally.
There are always concerns when translating an intervention from a controlled research environment to the relative disorder of the real world. But the balance of evidence was carefully considered before making the decision to change procedures for a group of patients who have a low likelihood of survival with current treatment.
Before using DSED, emergency medical personnel undergo mandatory education, simulation and training. Implementation is closely monitored to determine its impact.
Hospitals and emergency departments have been informed of the protocol changes and been given opportunities to ask questions and give feedback. As part of the implementation, the St John ambulance service will perform case reviews in addition to wider monitoring to ensure patient safety is prioritised.
Ultimately, those involved are optimistic this change to cardiac arrest management in New Zealand will have a positive impact on survival for affected patients.
Vinuli Withanarachchie, PhD candidate, College of Health, Massey University; Bridget Dicker, Associate Professor of Paramedicine, Auckland University of Technology, and Sarah Maessen, Research Associate, Auckland University of Technology
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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Nine Pints – by Rose George
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Rose George is not a scientist, but an investigative journalist. As such, she’s a leave-no-stone-unturned researcher, and that shows here.
The style throughout is, as one might expect, journalistic. But, she’s unafraid of diving into the science of it, interviewing many medical professionals as part of her work. She also looks to people living with various blood-related conditions, ranging from hemophilia to HIV.
Speakling of highly-stigmatized yet very manageable conditions, there’s also a fair section devoted to menstruation, menstrual blood, and societies’ responses to such, from shunning to active support.
We also learn about the industrialization of blood—from blood banks to plasma labs to leech farms. You probably knew leeches are still used as a medical tool in even the most high-tech of hospitals, but you’ll doubtlessly learn a fascinating thing or two from the “insider views” along the way.
Bottom line: if you’d like to know more about the red stuff in all its marvelous aspects, with neither sensationalization nor sanitization (the topic needs neither!), this is the book for you.
Click here to check out Nine Pints, and learn more about yours!
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Beyond Burger vs Beef Burger – Which is Healthier?
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Our Verdict
When comparing the Beyond Burger to a grass-fed beef burger, we picked the Beyond Burger—but it was very close.
Why?
The macronutrient profiles of the two are almost identical, including the amount of protein, the amount of fat, and the amount of that fat that’s saturated.
Where they stand apart is in two ways:
1) Red meat is classed as a group 2A carcinogen
2) The Beyond Burger contains more sodium (about 1/5 of the daily allowance according to the AHA, or 1/4 of the daily allowance according to the WHO)Neither of those things are great, so how to decide which is worse?
• Cancer and heart disease are both killers, with heart disease claiming more victims.
• However, we do need some sodium to live, whereas we don’t need carcinogens to live.Tie-breaker: the sodium content in the Beyond Burger is likely to be offset by the fact that it’s a fully seasoned burger and will be eaten as-is, whereas the beef burger will doubtlessly have seasonings added before it’s eaten—which may cause it to equal or even exceed the salt content of the Beyond Burger.
The cancer risk for the beef burger, meanwhile, stays one-sided.
One thing’s for sure though: neither of them are exactly a cornerstone of a healthy diet, and either are best enjoyed as an occasional indulgence.
Some further reading:
• Lesser-Known Salt Risks
• Food Choices And Cancer Risk
• Hypertension: Factors Far More Relevant Than SaltDon’t Forget…
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Strategic Wellness
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Strategic Wellness: planning ahead for a better life!
This is Dr. Michael Roizen. With hundreds of peer-reviewed publications and 14 US patents, his work has been focused on the importance of lifestyle factors in healthy living. He’s the Chief Wellness Officer at the world-famous Cleveland Clinic, and is known for his “RealAge” test and related personalized healthcare services.
If you’re curious about that, you can take the RealAge test here.
(they will require you inputting your email address if you do, though)
What’s his thing?
Dr. Roizen is all about optimizing health through lifestyle factors—most notably, diet and exercise. Of those, he is particularly keen on optimizing nutritional habits.
Is this just the Mediterranean Diet again?
Nope! Although: he does also advocate for that. But there’s more, he makes the case for what he calls “circadian eating”, optimally timing what we eat and when.
Is that just Intermittent Fasting again?
Nope! Although: he does also advocate for that. But there’s more:
Dr. Roizen takes a more scientific approach. Which isn’t to say that intermittent fasting is unscientific—on the contrary, there’s mountains of evidence for it being a healthful practice for most people. But while people tend to organize their intermittent fasting purely according to convenience, he notes some additional factors to take into account, including:
- We are evolved to eat when the sun is up
- We are evolved to be active before eating (think: hunting and gathering)
- Our insulin resistance increases as the day goes on
Now, if you’ve a quick mind about you, you’ll have noticed that this means:
- We should keep our eating to a particular time window (classic intermittent fasting), and/but that time window should be while the sun is up
- We should not roll out of bed and immediately breakfast; we need to be active for a bit first (moderate exercise is fine—this writer does her daily grocery-shopping trip on foot before breakfast, for instance… getting out there and hunting and gathering those groceries!)
- We should not, however, eat too much later in the day (so, dinner should be the smallest meal of the day)
The latter item is the one that’s perhaps biggest change for most people. His tips for making this as easy as possible include:
- Over-cater for dinner, but eat only one portion of it, and save the rest for an early-afternoon lunch
- First, however, enjoy a nutrient-dense protein-centric breakfast with at least some fibrous vegetation, for example:
- Salmon and asparagus
- Scrambled tofu and kale
- Yogurt and blueberries
Enjoy!
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How Useful Is Peppermint, Really?
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Peppermint For Digestion & Against Nausea
Peppermint is often enjoyed to aid digestion, and sometimes as a remedy for nausea, but what does the science say about these uses?
Peppermint and digestion
In short: it works! (but beware)
Most studies on peppermint and digestion, that have been conducted with humans, have been with regard to IBS, but its efficacy seems quite broad:
❝Peppermint oil is a natural product which affects physiology throughout the gastrointestinal tract, has been used successfully for several clinical disorders, and appears to have a good safety profile.❞
However, and this is important: if your digestive problem is GERD, then you may want to skip it:
❝The univariate logistic regression analysis showed the following risk factors: eating 1–2 meals per day (OR = 3.50, 95% CI: 1.75–6.98), everyday consumption of peppermint tea (OR = 2.00, 95% CI: 1.14–3.50), and eating one, big meal in the evening instead of dinner and supper (OR = 1.80, 95% CI: 1.05–3.11).
The multivariate analysis confirmed that frequent peppermint tea consumption was a risk factor (OR = 2.00, 95% CI: 1.08–3.70).❞
~ Dr. Jarosz & Dr. Taraszewska
Source: Risk factors for gastroesophageal reflux disease: the role of diet
Peppermint and nausea
Peppermint is also sometimes recommended as a nausea remedy. Does it work?
The answer is: maybe
The thing with nausea is it is a symptom with a lot of possible causes, so effectiveness of remedies may vary. But for example:
- Aromatherapy for treatment of postoperative nausea and vomiting ← no better than placebo
- The Effect of Combined Inhalation Aromatherapy with Lemon and Peppermint on Nausea and Vomiting of Pregnancy: A Double-Blind, Randomized Clinical Trial ← initially no better than placebo, then performed better on subsequent days
- The Effects of Peppermint Oil on Nausea, Vomiting and Retching in Cancer Patients Undergoing Chemotherapy: An Open Label Quasi-Randomized Controlled Pilot Study ← significant benefit immediately
Summary
Peppermint is useful against wide variety of gastrointestinal disorders, including IBS, but very definitely excluding GERD (in the case of GERD, it may make things worse)
Peppermint may help with nausea, depending on the cause.
Where can I get some?
Peppermint tea, and peppermint oil, you can probably find in your local supermarket (as well as fresh mint leaves, perhaps).
For the “heavy guns” that is peppermint essential oil, here’s an example product on Amazon for your convenience
Enjoy!
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