The journals: My monthly potpourri


You just ate the biggest burger in town. You get a little sweaty and have an ache under your breastbone. You decide to wait for it to go away.

If it’s the big one, does the delay really matter? What if you elect to call a taxi and wait 15 minutes? Does the time to start treatment make any difference? Assuming competent medical care, does the type of intervention matter?

I’ll start this November potpourri with a relevant article from the New England Journal of Medicine’s Sept. 5 edition

  1. The way that an unstable plaque causes a heart attack was covered in a previous article. I’ll rerun it on my Facebook page.

After a coronary artery is blocked, injury occurs in 20-30 minutes. Necrosis of heart muscle can take hours. Therapy is aimed at rapidly re-establishing the patency of the vessel by injecting drugs to break down the clot or by passing a catheter into the artery and reopening the obstruction with a tiny balloon. That technique, a percutaneous coronary intervention, has become preferred, if it is available.

A goal of less than 90 minutes has been set for the time between entering the hospital and having a balloon in place. The effort to rush patients to the procedure room has not proven to be effective. The focus is changing to shortening the time from the first symptom to the intervention.

Emergency medical technicians will have the electrocardiogram done on the way to the hospital. Patients who take nitroglycerin for chest pain should get help if the medication hasn’t helped within five minutes.

My opinion: Shortening the time to treatment makes sense. We need to prove what works and what doesn’t. Diet and exercise, aspirin and statins do reduce the likelihood that you will have to make that 911 call.

I’ve written about the value of vegetarian diets, and I listened to Dr. Esselstyn’s lecture on the subject at Whitman College on Sept. 15. Some of his conclusions differ from those of other researchers. I’ll deal with those in my longevity related articles.

  1. Scientific American’s September edition reports on the effects of fracking on water supplies in Pennsylvania. Much of that state rests on the Marcellus Shale formation.

A chemical engineer from Duke University tested 141 residential wells — 115 tested positive for methane. The highest levels, six times higher than others, were in wells closest to the fracking site. The drilling company denied that its wells could leak.

My opinion: America needs to seek energy independence and to create jobs. Corporations need to discuss scientifically verifiable realities, establish credible partnerships, and move concern about public health from the public relations department to the boardroom.

  1. Sexual differentiation involves much more than whether you got a Y (male) chromosome. In simplest terms, our DNA is a template for the things our body makes, including our hormones.

The intensity with which those hormones are expressed involves intermediate steps that can crank production up or down, or change it completely.

The journal Science, Sept. 6, published an article with a title that may stop you from reading further, but try to hang in with me. “Epigenetic Regulation of Mouse Sex Determination by the Histone Demethylase Jmjd1a” can be broken down into understandable parts.

Epigenetic is a firmly established concept. Our genes express themselves differently, based on outside — epigenetic — factors.

The chemical reaction of methylation is important in changing the final outcome of having a certain gene. Therefore a demethylase can make dramatic changes, like producing a mouse with a male chromosome that is born with partial changes in sexual expression, extend from a male with ovaries or with one ovary and one testicle.

My opinion: The chemistry of human DNA, RNA and epigenetics are much the same as those in a lab mouse. The DNA we inherit can manifest itself in different ways. Environment and training contribute to epigenetic changes, without controlling everything.

Tell your sons and daughters to talk with you about their science classes. Maybe both of you will learn from the exchange, and you’ll be able to discuss the interface of science and your beliefs.

  1. The Aug. 16 issue of Science, updates us on an old question. Do pesticides contribute to the development of Parkinson’s disease and, possibly, Alzheimers, ALS and other neurologic disorders?

The article refers to a review of 100 studies that link chronic, low dose exposure to Parkinson’s. There is concern about the quality of some studies and uncertainty about which agents are the most dangerous.

A strong correlation exists between use of the herbicide Paraquat and Parkinson’s. Other correlations appear to indict organochlorine insecticides.

In California, organophosphate exposure has been linked to mental impairment in the children of Mexican farmworkers.

My opinion: Toxicity data for farm chemicals has the same failings as evaluating medicines and medical equipment. We can only conveniently judge acute problems.

We do know that many of the pesticides are designed to damage the nervous system. They interfere with an enzyme that allows transmission of data among nerve cells.

It’s reasonable to question why they might have a cumulative effect on our brains and those of infants and children.

At one time, there was concern that 2-4 D was causing lymphomas. I looked at data in our region and found no evidence it was occurring here. I don’t think I’m being alarmist to urge caution now and further studies in the near future.

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


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