Syphilis Rate Increasing

Syphilis is a sexually transmitted infection that, if untreated, can cause multiple health problems as it goes through 3 stages. A review article by Amerson and colleagues in JAMA Network on September 27, 2022 described indications for testing.

Syphilis has been increasing in frequency since 2001 (increased three-fold over the following 18 years). Who is at greater risk than others? The highest rate is among men who have sex with men (57% of new cases). Although syphilis is more common in men regardless of sexual orientation, the rate in women has tripled between 2015 and 2019.

The increased rate of syphilis in women has increased the rate of congenital syphilis (babies born with it). Congenital syphilis can cause “miscarriages, stillbirth, neonatal death, low birth weight,” or signs of congenital syphilis.

Risk of getting syphilis is also increased in non-Hispanic black men and women; the highest rate is in non-Hispanic “American Indian and Alaska Native women.” Higher risk is also present among people with “HIV, methamphetamine or opioid use disorder, young adults, and a history of incarceration, transactional sex (prostitution), or military service.”

The authors recommend testing for syphilis in anyone with signs of syphilis such as a painless skin ulcer on the genitals, anus, or mouth.

Screening patients without signs or symptoms of syphilis is recommended by the authors in men who have sex with men and people with HIV. Tests should be done annually. Other people in a high risk category should be considered for annual testing on a case by case basis.

Pregnant women should be tested at their first prenatal visit. If the woman is at high risk, repeat testing at the beginning of the third trimester and at delivery.

When a screening test is positive, testing for other sexually transmitted diseases should also be done. Adolescent and adult women should also have a pregnancy test performed.

In my opinion, these guidelines should be modified for an individual patient based on the specifics of the case. Decisions should be made jointly by the patient and their doctor.

Peter M. Hartmann, MD

Family Medicine and Psychiatry

Is Western Math Racist?

There is a claim that Western math is racist. This is partly because teachers expect students to get the “right” answer because there is a “right answer.”

2+ 2 = 4 is true but so is 2+ 2 = 5, they say. Math is not objective and universal (true everywhere in the world) is also something they claim.

The word to describe this approach to math is “ethnomathematics.” If you want to understand what this is about, you will find answers in my book, Critical Race Theory and K-12 Education.

Buy it on Amazon ($4.99 for the ebook; $5.50 for the paperback). Type peter hartmann in the search bar.

Former Smokers and Mortality

An article by Inoue-Choi and colleagues in JAMA Network Open on September 22, 2022 addressed the health status of former smokers. They point out that “The benefits of smoking cessation are well known, but former smokers have a higher health risk than never smokers.”

What can former smokers do to further reduce their risk of premature death? Does following healthy lifestyle recommendations help former smokers?

To answer these questions the researchers compared death rates of former smokers who followed healthy lifestyle recommendations compared to former smokers who don’t. The healthy lifestyle recommendations included maintaining a healthy weight, eating healthy foods, engaging in regular physical activity, and drinking alcohol only in moderation.

Those former smokers who followed these recommendations had a 27% lower risk of death from any cause than those who didn’t.

If you or a loved one is a former smoker, following a healthy lifestyle can lower the risk of premature death. These recommendations can be found at http://www.cdc.gov.

Peter M. Hartmann, MD

Family Medicine & Psychiatry

Cancer Risk and Sugar in Drinks

HealthDay reported on a news release from the American Cancer Society on September 15, 2022 about a relationship between drinking sugary drinks and cancer.

In the report, Cancer, Epidemiology, Biomarkers and Prevention the ACS wrote “drinking too many sugary beverages may increase the risk of death from cancer.” They went on to say, “These sugar-sweetened beverages were associated with increased death rates from colon and kidney cancer.” That was true regardless of a person’s BMI.

The report noted that “study participants who consumed artificially sweetened beverages also had an increased risk of pancreatic cancer.” So, drinking too many sweetened drinks may increase your risk of colon and kidney cancer, and using artificial sweeteners increases your risk of cancer of the pancreas.

We already know that excess body fat increases the risk for certain cancers. Trying to lose weight by drinking only artificially sweetend drinks may increase the risk of cancer of the pancreas. Other approaches to weight loss may be safer.

Peter M. Hartmann, MD

Family Medicine & Psychiatry

Gene Editing:A Modern Marvel

In 2020 two scientists (Emmanuelle Charpentier and Jennifer Doudna) received the Nobel Prize in chemistry for developing a technology for editing genes. Basically, that means cutting DNA wherever you want (gene editing).

Being able to precisely cut genes means that you can shut unwanted gene action down or add missing components to correct an abnormal gene. This opens the possibility of treating genetic illnesses by “fixing” the abnormal gene.

This technology is named CRISPR genome editing. Information about advances in the use of CRISPR technology is in the news, so this blog is intended to give you a basic grasp of what it’s about.

Although use of CRISPR gene editing is still in early phases of research for treating genetic diseases, there have been some exciting trials. For example, 11 patients with sickle cell disease have been treated by collecting certain bone marrow cells and editing the gene responsible for sickle cell disease.

These modified cells are re-introduced into the body. Over a period of 1 to 3 years, the patients have had a significant reduction in sickle cell crises in which red blood cells change shape and clog small blood vessels. This causes severe pain and damages tissue fed by these blood vessels.

The reduction in sickle cell crises has not been accompanied by any significant adverse side-effects. So far, this treatment appears to be both safe and effective.

Additional clinical trials have used CRISPR technology to treat other genetic disorders such as a rare disease of the retina of the eyes, reducing an abnormal protein (amyloid) in the liver, and hereditary angioedema (rare genetic disease with rapid swelling of tissue in multiple areas of the body such as hands, face, GI tract, and the airway).

In the future, it is expected that CRISPR will be used to reduce production of a protein that causes increased cholesterol and resultant heart disease and stroke. Already, clinical trials have started on treating cancer using modified T-cells in the body that attack and kill cancer cells. Engineered pancreas cells are being tested to treat type 1 diabetes.

CRISPR is an amazing technology that is going to change medicine as we know it. From a medical perspective, this is an exciting time to be alive.

Much of this blog is based on an article by Kan and Doudna in JAMA 2022; 328(10).

Peter M. Hartmann, MD

Family Medicine & Psychiatry

Alzheimer’s Prevention

Most of us dread the possibility of getting Alzheimer’s dementia. What can be done to prevent it? There are a number of preventive strategies, and one is based on social support.

Salinas and colleagues reported on research on this topic in JAMA Network Open on August 16, 2021. Researchers noted that “prior studies have shown social support reduces Alzheimer’s disease and related disorders by increasing cognitive resilience.” Cognitive resilience means that the brain is able to resist the bad effects of changes in brain structure due to advancing age or disease.

The researchers wanted to know if there was a specific type of social support that was particularly helpful in preventing Alzheimer’s. They compared supportive listening, giving advice, showing love and affection, emotional support, and sufficient contact (spending time with other people).

I was surprised to learn that supportive listening was the form of social support that increased cognitive resilience the most.

Supportive listening involves encouraging someone to talk about whatever concerns them. The listener focuses on what the person is saying with the intention of understanding without judgment. The listener asks about feelings and asks questions to clarify what the person is trying to communicate. A supportive listener does not focus on giving advice but expresses empathy.

We know that loneliness and social isolation are risk factors for Alzheimer’s and related diseases. It appears that supportive listening is an antidote.

If you want to know more about loneliness see my video podcast on that topic on YouTube. Search for loneliness and Peter Hartmann.

What is Critical Race Theory?

Critical Race Theory (CRT) is in the news, but what is it really? The law professor who coined the term has started a campaign called #TruthBeTold, which explains what it is today.

The same law school professor has publicly said that CRT is not being taught in K-12 schools. So, what is being taught that has created conflict?

The #TruthBeTold campaign is described and details about what is being taught at the K-12 level are covered in my book (see above). It is available on Amazon where it has been rated 5 out of 5 stars.

The ebook is $4.99, and the paperback is $5.50.

What is Digital Self-harm?

Digital self-harm means to anonymously put “hurtful content” about yourself on social media. Because it is anonymous, readers don’t know that the bad things said about you are what you think about yourself.

About 9% of teens do this. This likely represents an attempt to self-harm by trashing your reputation. Doing it anonymously makes it appear that someone else thinks badly of you.

A “survey of 4,972 American middle and high school students” showed that kids who anonymously publish bad things about themselves are up to 7 times more likely to have suicidal thoughts and up to 15 times the rate of suicide attempts compared to kids who don’t engage in digital self-harm.

Yesterday, I published a blog about shame. One response to shame is called “attack self.” I think that digital self-harm is an example of that. When you feel shame, you believe that you are a bad person.

Kids who engage in digital self-harm because of shame demonstrate the problem with the 4 responses to shame discussed in my blog. Anyone who engages in digital self-harm should talk about it with a trusted adult.

The survey results were published in the psychiatry journal, Child and Adolescent Mental Health on July 10, 2022.

Shame: How to Respond

Shame is one of the 9 primary emotions (technically, they are called, affects, which are the innate biological part of emotions). When we experience shame, we say to ourselves, “I am bad.” In contrast, when we feel guilty, we say, “I did a bad thing.”

Donald Nathanson, MD is a psychiatrist who is an expert on shame. He discovered that people react to feeling shame in 4 possible ways. They can be plotted out as if they were points on a compass, representing the 4 cardinal positions (North, South, East, West).

Response 1: Attack Self. In this case you believe that your shame is valid, and you are angry at yourself as a result. You criticize yourself and may even feel contempt. You may deal with your shame by subordinating yourself to others. As a result, you may do what others want you to do even if it is not in your best interests. You can lose your sense of autonomy.

Response 2: Attack Other. You project your sense of being bad by blaming others. You may put others down to make you feel better about yourself. In the worst case you may physically abuse someone else. Obviously, attacking others to reduce your shame is damaging to your relationships and does not directly address the shame.

Response 3: Avoidance. You think and act in ways that allow you to avoid feeling the shame. You may do this by distracting yourself by engaging in more sex, eating just for pleasure, or using alcohol or drugs (especially stimulants) to mask shame. Using substances in this way prevents you from dealing with your underlying shame. Alternatively, you may do things that increase pride in yourself such as being more charitable, learning a challenging new skill, etc.

Response 4: Withdrawl. As is the case with Attack Self, you accept that your shame is valid so you withdraw from situations to avoid shame. You may turn down invitations from others, turn to solitary activities, and cut off friendships. Although withdrawal may lesson a sense of shame (“People can tell that I am bad so I will stay away”), cutting yourself off from support is an unhealthy response to shame.

If you struggle with shame, you may find it helpful to figure out which of the four responses you are using to deal with it. It may be that you use more than one of these defenses. None of them are optimal responses, and they may make your life worse.

Seeing a therapist is a good idea if you are unsure if you are dealing with shame, depression or other psychological states. Therapy is also useful to figure out which defenses you are using and how to modify your responses in a healthier way.

Peter M. Hartmann, MD

Family Medicine & Psychiatry