HEALTH EFFECTS OF ATOMIC BOMB RESEARCH

The Department of Energy recently announced that it may reduce funding for the Radiation Effects Research Foundation, RERF (Malakoff D D and D Normile. Science 2004; 304: 33. News. U. S. Could Pull Back on Studies of Atom Bomb Survivors). The latter has been following the 280,000 survivors of the atomic bombings of Hiroshima and Nagasaki and their children. Currently, research is being conducted to explore the possible association to exposure to radiation and higher rates of cardiovascular disease. The size of any cuts is still being negotiated between DOE and the White House.

COMMENT: I certainly hope that the U. S. will continue to fund this research. I think the studies of the health effects of the nuclear bombings of Hiroshima and Nagasaki have added more to our knowledge of such matters than any other single investigation conducted regarding the health effects of ionizing radiation.

AMERICAN’S HEALTH BEHAVIORS

The following findings are from the data collected during a three year period for the National Health Interview Survey ( National Center for Health Statistics. News release, February 25, 2004. New report examines American’s Health Behavior).

ALCOHOL USE

Six of 10 respondents were current drinkers in 1999-2001. About one person of every four was a lifetime abstainer. Almost one-third of respondents were classified as light drinkers (3 or fewer drinks per week), and nearly 5 percent were heavy drinkers (7 or more drinkers per week for women; 14 or more for men).

SMOKING

About 23 percent of respondents said they were current smokers. About the same proportion were former smokers, and over half of U. S. adults had never smoked cigarettes.

LEISURE-TIME PHYSICAL ACTIVITY

Slightly more than 60 percent of adults engaged in some leisure-time activity, and one in ten adults engaged in vigorous activity at least five times a week.

BODY WEIGHT

Almost 22 percent of adults were obese (had a body mass index of 30 or higher); 35 percent were overweight (body mass index of 25 or greater but less than 30); 40 percent were in a healthy weight range.

COMMENT: I find it particularly disquieting that 23 percent of American adults still smoke cigarettes. Not long ago Secretary Thompson announced a new, national initiative to help smokers kick the habit. I hope it gets off the ground.

MORTALITY AMONG PROSTITUTES

Potterat and his colleagues identified prostitutes in Colorado Springs, Colorado from police records and health department records, i. e., visits to drug treatment clinics, STD clinics, HIV clinics, etc., during the 1967 to 1991 period. The authors identified 1,969 prostitutes and used the National Death Index and the Social Security Death Index to assess cause-specific mortality of the 117 deaths identified in the cohort. The standardized mortality ratio adjusted for age and race was 1.9 (95% CI: 1.5-2.3). Nineteen (19) percent of deaths were due to murder, and 18 percent were due to drug ingestion. The authors concluded that “women engaged in prostitution face the most dangerous occupational environment in the United States.”

COMMENT: This article attracted my attention because the study population was so unusual and because I practiced medicine in Colorado Springs from 1950 to 1964. I was quite surprised to learn that the oldest profession was such a dangerous one. The homicide rate for prostitutes in Colorado Springs was 204 per 100,000. The authors pointed out that the highest homicide rates in the United States during the 1980s were for female liquor store workers (4 per 100,000) and for male taxicab drivers (29 per 100,000). I was surprised to read some years ago that the homicide rate was very high for women employed to clean hotel and motel rooms. The authors of that paper assumed their deaths probably occurred when they inadvertently entered rooms while illicit drug deals were underway.

FREQUENCY OF EJACULATION AND PROSTATE CANCER RISK

The Health Professionals Study was initiated in 1986. Slightly more 51,500 mostly white health professionals responded to a questionnaire about their medical histories and risk factors for various chronic diseases. Follow up questionnaires were sent out every two years thereafter, and in 1992 participants were asked to report the average number of ejaculations, including sexual intercourse, nocturnal emissions, and masturbation, they had during the ages of 20 to 29 years, 40 to 49 years, and during the past year, 1991, (Leitzmann MF et al. Ejaculation frequency and subsequent risk of prostate cancer. JAMA 2004; 292: 1878-1586.

The relative risk was calculated as the incidence rate of prostate cancer among respondents with a given category of ejaculation frequency divided by a common reference group with adjustment for age, 4 – 7 ejaculations per month. Multivariate RRs were estimated using the Cox proportional hazards model. Covariates included racial group, family history of cancer, history of vasectomy, body mass index, pack-years of smoking, history of type 2 diabetes, vigorous physical activity, and various dietary intakes, including alcohol.

Men with greater lifetime ejaculation frequency tended to be physically more active and were more likely to have a history of yphilis or gonorrhea, prostatitis, and vasectomy than men with lower ejaculation frequency. Men with greater lifetime ejaculation frequency also were more likely to be currently divorced or separated, and to consume more alcohol.

In multivariate adjusted analyses, most categories of ejaculation frequency were unrelated to risk of prostate cancer. However, lower risk was apparent in the highest category of ejaculation frequency. The multivariate RRs for men reporting 21 or more ejaculations a month compared with men reporting between 4 and 7 ejaculations per month at ages 20 to 29 years was 0.89 (95% CI, 0.73-2.20; 40 to 49 years, 0.68 (95% CI, 0.53-0.86; and across a lifetime, 0.57 (95% CI, 0.51-0.89.

COMMENT: The co-investigators of this study included Meir Stampfer, Walter Willett, and Edward Giovannucci, all extremely able, experienced epidemiologists, and only a very foolish, old man would be critical of their work. I am an old man, and I will be foolish.

It seems to me that there is a striking and important difference between ejaculations associated with nocturnal emissions and masturbation and ejaculations associated with sexual intercourse, homosexual or heterosexual. Nocturnal emissions and masturbation are not associated with exposure to potentially pathogenic organisms. Sexual intercourse may be associated with exposure to potentially pathogenic organisms, including the human papilloma viruses, the genital herpes virus, the gonococcus, the Treponema pallidum, HIV, the trichomonas organism, the Monilia, and other organisms. Of course, not all such exposures result in clinically apparent disease. I think this study would have been much more useful had it been confined to ejaculations associated with sexual intercourse. The inclusion of ejaculations associated with nocturnal emissions and masturbation has only muddied the waters.