The journals: My monthly potpourri


Current literature spans issues from testosterone to the reason that farmers get smarter in the wintertime. So without further ado:

  1. We don’t have a good way to define ideal testosterone levels. The big question of whether low T levels should be replaced in older men will be addressed later, in a longer article about longevity.

The New England Journal of Medicine’s Sept. 12 edition helps us to understand conflicting data. To make sense of the study, you need to know that a portion of male hormones changes chemically to provide 80 percent of the female hormone, estradiol, found in men. This study shows that ideal levels are different, depending what you and your doctor want to accomplish.

Muscle mass and strength don’t decrease until T levels become quite low, but there are variations from one man to another. Erectile function and sexual interest increase as T levels are raised, but the estradiol level also plays a role. Relatively small decreases in female hormone levels are associated with an accumulation of bad fat.

My opinion: This study adds to our understanding of a complex issue. I go a little bit bonkers when a TV ad spews out a dozen possible complications, without taking a breath. The risks of raising T levels in older men include fluid accumulation and an increased incidence of heart failure.

At the same time, there seems to a favorable effect on metabolic syndrome features and could increase longevity. The low T question pleads for more ink — later.

  1. A study of more than 100,000 responders suggests we are influenced by a herding effect.

The Aug. 8 edition of Science invited reviews of products. Researchers then showed reviewers the results of earlier opinions. The trick was that those “earlier opinions” weren’t real. Some were artificially high and some were low.

The reviewers — the test subjects — moved their ratings dramatically in the direction of what they believed other people thought.

My opinion: Our behavior is easily manipulated. Consider the social and economic consequences.

  1. The Sept. 12 NEJM reports that prescription opioid use increased 300 percent in the 10 years ending in 2010. Deaths have also increased dramatically.

There has been a proliferation of pill mills, where physicians can become wealthy providing large amounts of drugs that pharmacies will usually fill without comment.

My opinion: Pharmacists and the public could help to reduce the problem. We need an occasional call to responsibility. The medium could be online or, maybe, letters to the editor. I’d like to see thinking on some new subject matter.

  1. Thirty five years ago, science set off a conflict over in vitro fertilization, the first test-tube babies. A new study has ignited the same kind of confrontation.

An experiment is being done in England. I had the good fortune to be in the British Isles this summer and I heard some of the discussions.

Opponents regard the work as dangerous and unnatural because the result is a baby with three parents. The explanation is straightforward. We know that a baby gets half of its DNA from each parent. There is a third kind of DNA that comes from our mothers. It defines the function of our mitochondria. These are tiny parts of the cell that control the availability of energy to support cell function. There are mitochondrial diseases that affect about 1 in 5,000 births.

If the research works, and it probably will, then women who carry potentially fatal mitochondrial genes can have a normal baby. The procedure requires replacing the tiny bit of mitochondrial DNA from a third person.

The issue was covered in the August issue of “Popular Science.”

My opinion: I’m a physician and we’re compelled to fix things. I weigh my decisions in a moral context but lean in favor of combating pain and suffering.

  1. Zolpidem, prescribed as Ambien and other names, is usually prescribed in 10 mg doses. It has been felt that the risk of next-day somnolence and driving impairment is small.

The Aug. 8 NEJM notes that older patients don’t clear it from their blood stream as well as younger ones. In addition, some people take the medication in the middle of the night, and there are some slow-release forms of these soporific agents.

My opinion: Since 1 in 5 traffic crashes involve sleepiness, it is prudent to use the lowest doses and the shortest acting drugs that are effective. I might repeat my earlier call to social responsibility. Driving impaired means more than booze and pot.

  1. Three institutions, including Stanford and two foreign universities, conclude that poverty impairs the ability to perform mental tasks well.

They conducted two experiments. In one, they matched test-takers who were comparable for variables except financial stresses. (They defined poverty as a gap between needs and resources.)

They also tested farmers pre-harvest and post-harvest. Cognitive abilities changed for the better once the money was in the bank and the snow was falling.

My opinion: It’s hard for me to argue that this is one of the critical findings in the recent literature. It may offer a meaningful insight into the problem a poor man or woman might have in making decisions that seem obvious to us.

For those of us with farmer friends, it may provide a way to understand ag-induced angst.

Dr. Larry Mulkerin is a retired clinical professor and oncologist who lives in Walla Walla. A former U.S. Army Green Berets medical officer with experience in the Middle East, he also is the author of “The Ayatollah’s Suitcase,” a novel available at and other online book retailers. He can be reached at


Use the comment form below to begin a discussion about this content.

Sign in to comment

Click here to sign in