Why reading medical journals is so fascinating: Are low nicotine cigarettes better? Does healthy lifestyle really protect your brain..and other stories

As I come closer to actually retiring, one might think I would stop reading the journals that arrive weekly. But they're too interesting. Sounds strange, with a whole world of interesting things to learn about, that they would continue to call to me, but wow. They are full of cool stuff.

Take, for instance, today's JAMA Open, a compendium of recent articles in all of the subspecialty journals from the American Medical Association. I wanted to get to other things on my always a little too long list, but there it was, so I read it:

1. Should we use Octenidine wipes (a less bad antibacterial-- it kills bacteria, fungi and viruses, used in Europe) or sterile water to clean babies in the ICU to prevent sepsis? Turns out sterile water works just as well. Yay biomes! Yay plain water! Don't kill all the things on the skin and babies are just as safe!

2. If the government requires cigarettes have very low nicotine, will people just smoke more cigarettes? Mostly, no. Will they smoke fewer? Previous studies show they will and fewer people will become addicted. People who smoke already, however, and had to smoke lower nicotine cigarettes got the extra nicotine they needed via vapes and other non cigarette means. Which is likely good, in terms of lung and heart disease.

3. Can MRI replace the digital rectal exam (feeling the prostate with a finger) in staging known prostate cancer. It can, but it isn't better at predicting who will do well. It is, of course, more expensive. It is better at designing treatments and guiding biopsy which will likely preserve sexual function. Almost everyone with prostate cancer is getting MRI's anyway, so this just says maybe they can stop getting uncomfortable manual exams. But if you just can't get an MRI (post apocalyptic or developing world scenario, or the American healthcare system just getting progressively crappier) you may not suffer much and won't die earlier.

4. Do children get cancer more if they live in poor areas? No, though they don't do as well if they are poor because of worse medical care, but kids in richer neighborhoods get cancer more. Why? It's a mystery. It's not a big effect, but warrants a little bit of further research.

5. Do salivary cortisol levels predict development of cognitive decline? Is it different in black and white populations? Yes, it appears to be good to have varying cortisol levels during a day, but not higher overall (maybe stimulation is good but chronic stress is not?) Black populations have lower overall cortisol and lower variation, but within that population, the variation in levels is still protective, and the higher overall levels are bad. These are not huge effects, and this testing is not coming to a primary care office near you anytime soon.

6. Is mistreatment of children something that causes later illness? This was a Taiwanese study and I did wonder how children were usually mistreated in Taiwan, information I couldn't find in the article. But they are. The study looked at injury bad enough to bring someone into the hospital, so pretty bad. And yes, it caused mental and physical illness over 9 years that they observed. They got more infections, diabetes and all sorts of things as well as injury and a variety of mental conditions. So treat your children well, as the old song goes.

7. Does delay in treatment of colon cancer cause it to be more likely to spread in the next 3 years? Yes, but a bit more complicated than you would think. If the person just needs surgery, not chemo or radiation therapy, it's a pretty big delay that causes a doubling of risk of spread. Over 200 days. With other routines, including chemo and surgery or chemo and radiation, delays of as little as 4 days may have an effect. This is confusing. I suspect it is more of a case of certain cancers are very likely to spread and time is of the essence and others are not so best to treat them all ASAP.

8. How do children born before 32 weeks do in school? They do have delays and it is much worse if they are in financially disadvantaged homes. It is important to support them, and perhaps delay starting school.

9. Is hydrocodone or oxycodone better at relieving pain after knee replacement? They are the same and hydrocodone causes less exposure to higher doses of opiates. So it's fine to go with hydrocodone. I also think that many people if given the option will go without opiates and do fine, though certainly not everyone.

10. Is buprenorphine/naltrexone (suboxone--a combination of opiate and opiate antagonist) better than long acting injectable naltrexone for preventing relapse for opiate addiction? Yes. Studies before have shown that people stick with the combination that includes the opiate (buprenorphine is probably better for preventing cravings and treat some of what people wanted to take illicit opiates for) and this study shows that they die from overdose less than the people treated with the naltrexone injection. So yes, better.

11. If you need an ablation (little electrosurgery done by cardiologist) to prevent atrial fibrillation (a common heart arrhythmia which can cause stroke and exercise intolerance) is it better to do it right away or wait? Better to do it sooner, because it works better.

12. Does healthier lifestyle in older people (70+) lead to better looking MRI scans of the white matter of the brain? Yes, looking at MRI's over 3 years showed that exercise, social engagement and dietary advice reduced the white matter free water, and starting these interventions younger made a bigger difference than starting them older.

13. Does continuing the SSRI antidepressant in pregnancy lead to significant problems for babies such as ICU admission or prematurity? Correcting for many more things than previous studies, it does not. There was a slight reduction in the APGAR score (Appearance, Pulse, Grimace, Activity and Respiration) which is used to see how perky a baby is right after birth, but otherwise taking these antidepressants during pregnancy didn't seem to be harmful, and it is very important that the mother not be depressed after her baby is born. Women are often made to feel terrible for taking care of their needs when they are pregnant, due to worries about effects on babies. This study says at least that continuing their antidepressants is probably fine.

So...it is still very interesting to read medical journals. In fact doctoring is still quite interesting. So for now I will continue a moderate amount of doctoring and I will happily read my journals. It will probably keep the white matter in my brain from getting wet (see #12.)