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I dusted off my bike a few weeks ago and have been riding it to and from work 2-3 times per week, weather and schedule permitting.  I’m fortunate to live less than one mile from our city’s bike trail system, I’m doubly fortunate that said system also deposits me within four blocks of my clinic, and I’m triply fortunate that it is a gorgeous ride.  For an activity that only adds a total of twenty minutes to my day (round-trip car ride takes twenty minutes, round-trip on the bike is forty) but burns close to 500 calories, it’s probably the most high-yield calorie-burning thing that I do.  Plus it gives me an excuse to wear some really obnoxious cycling gear, and in a profession like mine, you need a place to let out your crazy every now and then.

As an added bonus, in the latest edition of the Archives of Internal Medicine, bicycling has been associated with less weight gain in premenopausal women.

Bicycling, similar to brisk walking, is associated with less weight gain and an inverse dose-response relationship exists, especially among overweight and obese women.

Lusk A, Mekary R, et al.  Bicycle Riding, Walking, and Weight Gain in Premenopausal Women.  Arch Intern Med.  2010; 170 (12) 1050-1056.

Really, in my situation it’s almost silly not to.

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It has been uncharacteristically damp in my part of the Midwest lately which, while good for farmers, positively stinks for people like me who like a lot of outdoor activities.  Especially in an area where sub-zero temperatures force most exercisers indoors for several months of the year, not being able to exercise outdoors when the temperature is finally non-frigid is excruciating.

So this morning I awoke to thunder and lightning and slogged my butt to the gym, internally whining about the cosmic unfairness of thunderstorms that seem to occur only during prime workout time.  As I pedaled away on the stationary bike and mentally catalogued my misery, I began to overhear snippets of the conversation between one of the gym’s personal trainers and her client.  At the age of 32, this particular trainer had been recently diagnosed with metastatic breast cancer.  She was telling her client about how her scalp was bothering her and how she suspected it was a harbinger of imminent hair loss from her chemotherapy.  She was also talking about a recent wig-shopping trip, how she found one in a style she’d always wanted to try, how fun it would be to be blond one day and brunette the next.  How she wouldn’t wear them while working out—too hot, too itchy.

So I went an extra ten minutes on the stationary bike.  I will never complain about the rain again.

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…it might not be as effective as you think.

The Bee Gees were topping the charts with “Saturday Night Fever,” the first test-tube baby had just been born and gas cost 63 cents a gallon when the Food and Drug Administration began writing regulations for sunscreens.

Thirty-two years later, the agency has yet to issue its final regulations.

That means sunscreen manufacturers are not legally required to prove that their products meet advertising claims such as “waterproof,” “broad-based” or “lasts all day,” or that they offer a specific sun-protection factor, or SPF.

via After more than 30 years, FDA has yet to issue final regulations for sunscreens.

That’s great news for someone like me who has been relying on sunscreen for the past 20+ years so I can enjoy my usual outdoor activities.  For all I know I could have been slathering on expensive moisturizer.

On the other hand, a brief review of the medical literature seems to suggest that most sunscreen failures are more operator-dependent than product-dependent, so even with the strictest FDA regulations on sunscreens we are still our own worst enemies.  And anyway, while sunscreens (properly used) help reduce squamous-cell and basal-cell carcinomas, they don’t seem to have as much of an impact on the development of the more worrisome melanomas.

Fortunately, they also make sun-blocking clothing, although now that I think about it, I’ll bet no one’s making these manufacturers prove their products work, either.  Do they have an FDA equivalent for clothing?

Maybe I’d be better off with a parasol and a dermatology appointment.

Image by emildom75 via Flickr

But sadly, it’s probably my fault.  The twice-a-day feedings, the spontaneous belly rubs, the treats just for being freaking adorable, all have conspired to make domestic dogs the intellectual rivals of their squeak toys.

Domestic dogs have become so dependent on humans, they can no longer pass simple intelligence tests or solve problems which their counterparts in the wild find easy.

via Easy living dumbing down our pooches – oddstuff | Stuff.co.nz.

So my dog couldn’t find a bowl of food in a maze if his life depended on it.  So he’s scared of large serving bowls and lawn ornaments.  So he once ate an entire terra cotta planter.  So what?

Clearly I don’t own a dog for the intellectual stimulation.  I own a dog because he is genuinely thrilled to see me when I walk in the door.  I own a dog because he is the most reliable and enthusiastic running partner ever.  I own a dog because frankly, it’s hilarious to see an 85-lb beast run for his life when I take out a bowl to make pancakes for my kids in the morning.  I own a dog because he curls up at my feet and flops his head on my lap even if I’ve been a cranky pain in the butt. 

He’s a doofus, and I think he’s great.

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Perhaps when running for office?

U.S. Senate candidate Rand Paul says he is a “board-certified” ophthalmologist — even though the national clearinghouse for such certifications says he hasnt been for the past five years.   Rand Paul, who practices in Bowling Green, says he is certified by the National Board of Ophthalmology, a group that he incorporated in 1999 and that he heads.  But that entity is not recognized by the American Board of Medical Specialties, which works with the American Medical Association to approve such specialty boards.

via Rand Pauls ophthalmology certification not recognized by national clearinghouse | courier-journal.com | The Courier-Journal.

Frankly, I don’t care whether Rand Paul is board-certified or not.  Political leanings aside, I would have no problem with a physician running for office who wasn’t board-certified.  If he were operating on my eyeballs, yes, I’d be concerned; running for office, not so much.  But as a (legitimately) board-certified physician, I get a little cheesed when a physician claims to be board-certified when he is not, or at least not by the organization that is implied by the phrase “board-certified”.

This article states that Paul created the National Board of Ophthalmology, presumably the “board” that ”certified” him, out of frustration with the American Board of Ophthalmology’s requirements that younger physicians get re-certified every ten years.  It’s not an uncommon sentiment.  I had to re-certify last year; meanwhile a number of doctors with whom I work haven’t sat for a board exam since 1973 yet still maintain their certification.  It doesn’t seem right, I agree.  But the way I see it, my options were to not have board certification out of protest, or suck it up and take the exam.  I chose the latter.  I respect anyone’s decision to choose the other path, as long as they don’t present themselves as having done otherwise.  Which, sadly, does not appear to be the case here.

The issue is not so much ability as it is integrity.  Mr. Paul is quite possibly a fine ophthalmologist; I have no way of knowing for sure.  But to claim “board certification” based on a board of his own making when patients and employers alike rely on board certification to make important decisions seems a little troubling to me.

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Soon, your underwear may help manage your chronic medical conditions.

Scientists have invented underpants that can transmit its wearer’s vital signs to healthcare professionals.

Printed on the waistband and in constant contact with the skin is an electronic biosensor, designed to measure blood pressure, heart rate and other vital signs.

via U.S. scientists design smart underpants that could save lives – Yahoo! News.

The short-term intended audience is the US military.  It’s hoped that this technology will help medics monitor soldiers’ field injuries remotely.  Long-term, however, they hope to expand the skivvies’ duties to more complex diagnostics and even delivery of medications.  Which begs the question:  what happens when the prescription needs a refill?  And wouldn’t laundering be problematic?  Still, it’s an interesting concept.

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Lately I’ve been extolling the virtues of playing soccer–it’s part aerobic workout, part strategy game, part drama class, and has even been shown to ward off osteoporosis.  But I never stopped to think about the people on the field who are getting the best workout of all–the referees.

Referees, who can be twice the age of the players, sprint across the field keeping up with the players and closely tracking the action. They tend to run 12 miles during the game — five more than the players, according to data from the U.S. Soccer Federation.

via World Cup referees outrun players – CNN.com.

This article is worth reading in its entirety.  The workouts that these guys endure are nuts, and then they have to pass a series of fitness tests to prove that they’re up to the task of supervising a World Cup soccer game.  And unlike the players, they don’t get subs.

So if you’re a soccer player, my hat’s off to you.  It’s a great workout.  But if you’re a soccer referee, I’m in awe.

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Soon your cardiologist may be handing you a toothbrush as you walk out the door.

British researchers studied nearly 12,000 adults in Scotland and found those with poor oral hygiene had a 70 percent extra risk of heart disease compared with those who brushed twice a day and who were less likely to have unhealthy gums.

via Regular teeth brushing linked to healthier hearts | Reuters.

This actually isn’t entirely new.  For years scientists have known that periodontal disease is associated with coronary artery disease.  And while it would seem that this would go without saying, this is the first study that I’m aware of that looks at frequency of brushing and its relation to heart disease.  I’m sure they’ll look at flossing next, if they haven’t started already, at which point my dentist is sure to give me an earful.

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One of the many hats I sometimes wear is reviewer of submitted articles to a major medical journal.  Maybe I’m a bit of a geek, but I take this role very seriously:  I don’t want to be the guy who gave the thumbs-up to a study, only to have it be published and found to be complete garbage.  By way of example, I’m sure the folks who reviewed the article that ultimately led to the downfall of a certain British doctor are feeling rather uncomfortable right now.

An area that I pay particular attention to is the statistics used in the study.  A huge pet peeve of mine, which I’m sure you’ll recognize if you’ve read any of my previous posts, is the reporting of relative risk to make an intervention seem more beneficial than it actually is.  Another is playing up the positive results while either downplaying the negative results, or ignoring them altogether.

A recent study suggests that my compulsions may be warranted.

More than half of 72 reports examined by French and British researchers had dressed up their conclusions to make it seem as if new treatments were beneficial, even though they weren’t according to the statistics in the report.

via Negative research often spun to look good: study | Reuters.

To me, this is incredibly disturbing. By allowing reports to be published with significant “spin”, we’re misleading the public and practitioners alike, sometimes with significant negative effects. For example:

When a clinical study was published in 2000 comparing Vioxx with an older drug, the authors downplayed the risk of heart attack: Instead of reporting the five-fold increase in risk, they chose to frame it as a protective effect of the older drug.

via Negative research often spun to look good: study | Reuters.

This is why I’ve instituted a curriculum in statistics within the residency program I oversee. Physicians need to be able to critically review studies and have the tools to analyze the conclusions of the researchers. We need to empower individuals to honestly question research, even published research in peer-reviewed journals.

Now if you’ll excuse me, I have an article to review.

Burrito? Image by Getty Images Europe via @daylife

The Brevard County doctor who was arrested for groping a woman while dressed as Captain America with a burrito in his pants will not go to jail.

via No Jail Time For Man Arrested In Captain America Costume – News Story – WFTV Orlando.

Seriously.  I’m going to have to remember to not go out drinking next time I’m wearing my Wonder Woman outfit.