What friends' genes say about you

There's a lot of focus these days on tailoring treatments for diseases to individuals based on their genes, but friends' genes might be just as relevant, scientists argue.

It turns out that there are genetic correlations among people in the same social group, a new study in the journal Proceedings of the National Academy of Sciences finds.

"We’re not just a product of our own genes, but those of others around us," said study co-author James Fowler, associate professor at the University of California, San Diego. Fowler and Dr. Nicholas Christakis of Harvard, another study collaborator, previously penned a book called Connected detailing how everything from obesity to happiness to loneliness seems to spread in social networks.

Obese? What your doc may be overlooking

(Health.com) -- Ann Silk, MD, worries about her overweight patients. But Dr. Silk, an internal-medicine resident at the University of Pittsburgh Medical Center, isn't concerned only about their diets and cholesterol levels.

She also worries that the fatty tissue on their bodies will obscure other health problems, like tumors.

Although excess weight is hard on a patient's body, it's also hard on doctors who are trying to perform physical exams.

Blood pressure cuffs have to be bigger. Stethoscopes can't pick up subtle heart abnormalities and lung sounds muffled by flesh. And medical scales often max out at 350 pounds -- making it hard to determine exactly how overweight the largest patients are.

Moreover, excess body fat can interfere with a doctor's ability to assess thyroid or liver health or recognize abnormal growths.

Even with all the high-tech medical tools at their disposal, doctors still find out some important, potentially life-saving information by touching and feeling their patients' bodies. Fat makes that job much tougher.

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"It's a worry that we're not finding what we need to find on exams because there is tissue in the way of our fingers, and in the way of our stethoscope," says Dr. Silk, who co-authored an article about this problem in this week's issue of the Journal of the American Medical Association.

"It leaves us with a little bit of uncertainty -- maybe you would even say insecurity -- whether we are identifying all the abnormalities on [an] exam."

In some cases, this uncertainty could lead to missed tumors or other oversights, Dr. Silk adds. "For the abdominal and gynecological exam, a mass would have to be pretty big before you could find it."

John Simmons, MD, an assistant professor of family and community medicine at the Texas A&M Health Science Center, in College Station, says that doctors can't identify conditions such as liver problems, hernias, and fluid buildup in the abdomen through physical exams alone.

Still, he says, abdominal, breast, thyroid, and genital examinations are particularly difficult in obese patients.

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For this reason, obese patients should be especially proactive about making sure they get regular screening tests, Dr. Simmons says. If necessary, they should "take it upon [themselves] to remind the doctor of potentially embarrassing but critically important screening tests like mammograms, Pap smears, genital exams, and colonoscopies."

The impact of obesity on physical examinations is still a new area of research, Dr. Silk says. To her knowledge, no studies have been conducted on whether excess body fat can delay serious diagnoses, and medical schools and textbooks appear to be lagging behind the rise in obesity rates.

More than one in three U.S. adults are obese, and two out of every three are overweight. The average American man and woman now weighs 195 pounds and 165 pounds, respectively -- about 18% more than they did in 1960.

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Dr. Silk and her co-author argue that the standard physical exam needs to be modified as a result. Here are some of the changes they say doctors and obese patients should consider during their next physical:

Longer breast exams. Some data suggests that a good breast exam takes three minutes per breast, but even longer in a heavier patient, Dr. Silk says. Doctors and patients should be prepared to spend some extra time on breast exams.

Rest before tests. Obese patients may grow short of breath after walking even brief distances, which could throw off readings for heart rate, blood pressure, and breathing rate. If needed, doctors should encourage obese patients to sit quietly for 15 minutes before checking their vital signs.

More elbow grease. Belly fat can make it harder for doctors to feel for liver problems or unhealthy fluid buildup in the abdomen, which means doctors may need to press extra firmly or spend more time on this area. "Patients have to be good sports at tolerating vigorous exams," Dr. Silk says.

Different instruments. Standard medical instruments may not be sufficient to examine heavier people. For instance, doctors may need to use a handheld imaging device known as a Doppler (rather than a stethoscope) to measure heart rate in obese patients, and they may need to use a longer speculum for gynecological exams.

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These changes aren't likely to address all the shortcomings of the physical exam, however. Medical training and textbooks will eventually need to be updated to reflect the obesity epidemic, Dr. Silk and her colleague write, and some doctors may need to invest in new technology and equipment.

Copyright Health Magazine 2010

Antibiotics speed up recovery from ear infections in young children, studies show

Giving babies and toddlers antibiotics when doctors are certain they have ear infections can help speed up their recovery, supporting current treatment guidelines for children between the ages of 6 months and 23 months.

However, antibiotics do come with significant side effects including diarrhea, rashes, yeast infections and vomiting. Overuse of drugs also contributes to antibiotic resistance, so careful selection of who should take antibiotics is necessary according to 2 studies published Wednesday in the New England Journal of Medicine.

According to one of the studies, ear infection, or acute otitis media, is the most frequently diagnosed illness in children in the United States, and most children with these ear infections are routinely given antibiotics.

But just 2 months ago, a new study confirmed practice guidelines from 2004, which recommend that children older than 2 with a confirmed diagnosis of an acute ear infection do not need to be given antibiotics because the drugs do not significantly speed up recovery.

The foundation for  the "watchful waiting" treatment recommendation instead of taking drugs is based on this and previous studies that  did not have very many children under age 2 in the clinical trials.  This made concluding that the same treatment works in the youngest age group very difficult.

These 2 new studies were designed to provide the research to  fill the gap, and clarify treatment recommendations for babies and toddlers.  The children in these latest trials had their ear infections confirmed by experts (otoscopists).  Researchers found that the youngsters who received a placebo did not recover as quickly as those getting the amoxicillin-clavulanate, an antibiotic that has been shown to be effective for earaches.

However the differences were not huge.  In the United States study, 80% of the children on antibiotics felt better on the seventh day of treatment; 74% of the children taking a placebo also felt better on the seventh day.

Dr. Jerome Klein, a pediatric infectious disease specialist from Boston University's Medical School, says in an accompanying editorial that these two studies resolve the controversy over giving antibiotics versus watchful waiting in kids with confirmed ear infections.

"More young children with a certain diagnosis of acute otitis media recover more quickly when they are treated with an appropriate antimicrobial agent," Klein wrote.

Dr. Richard Rosenfeld, who is a professor and chairman of otolaryngology at SUNY Downstate and Long Island College Hospital in Brooklyn, New York, has been charged with reviewing the 2004 American Academy of Pediatrics guidelines for treating ear infections.  He, too, has been eagerly awaiting the results of these 2 studies.

One of the strengths of both studies, Rosenfeld said,  is that the researchers took the time to make a solid diagnosis. Only children who really had ear infections were included in the trials.  But Rosenfeld  doesn't see the results as black and white as Klein.

"Medicine is about gray zones and balancing the risks and benefits," Rosenfeld says. "Parents and doctors need to understand what the benefits and what the downside of treatments are."

"If you received a placebo and you have a 74% chance of having symptoms go away or improvement [of illness]" – compared with the 80% in the antibiotic group ... "as a parent, how impressed are you about a 6% difference?"  In treatment outcomes for pain, there was no difference, he notes.

In both studies, children taking the real drugs had more side effects.  The study authors caution about the overuse of these drugs and the risk of antibiotic resistance.  The Finnish noted that limiting use of antibiotics may reduce the development of drug-resistant bacteria and increase the chance the future use of antibiotic will be effective.

Rosenfeld says it's never wrong to prescribe an antibiotic for a well-diagnosed ear infection. "If the child has high fever, severe ear pain, the child is really miserable, has a fever or draining from the ear or double ear infection and is under 2 years old, then prescribing antibiotic is probably the right thing to do."

But waiting to take the antibiotic isn't a bad idea either.  He says he frequently writes a prescription for parents but tells them to hold off from filling it for 3 days.  If the child still has symptoms 3 days later, then they should get the antibiotic and start giving it to their child. If you do that, 2 out of 3 parents don't fill out the prescription."

Which is why he says what to do is still not clear-cut.  He also points out that if antibiotics don't relieve a child's pain, pain medications will.

Rosenfeld believes these latest studies reinforce an important message: "It's an opportunity for a conversation with your pediatrician." Parents need to weigh the benefits of what antibiotics can do in terms of killing the bacteria (if the ear infection is caused by a bacteria and not a virus) and the side effects their child may have to endure, as well as the possibility that exposing bacteria to antimicrobials may make the drugs less effective in the future.