Journals: My monthly potpourri


In this month’s look at the journals we travel to Nova Scotia to touch on climate change, leave Walla Walla for prostate cancer treatment via expensive machines, then dive into the world of advertising to discuss claims about antioxidants. We conclude our trip by going down on the farm for a peek at ammonia pollution.

Buckle up.

1 The death of gray seals in Nova Scotia reflects one of the new problems associated with climate change. These seals have moved into an area where Arctic ice melted. They were infected with a new parasite, a strain of sarcocystis, which destroys their livers, reports the Feb. 21 edition of the journal Science,

My take: An expected effect of climate change has been the shift of diseases into new areas and the development of entirely new problems.

Animals and humans are vulnerable. We need to stay alert, even if changes seem limited to distant areas.

2 Patients often leave Walla Walla for treatment of prostate cancer with protons.

These new machines cost between $70 million and $200 million. The cost of treatments is high, not counting the expense of living out of town.

I will include these treatments in a series of articles on prostate cancer. I’m electing to add information on this to a potpourri because of a paper published in 2013.

“Principles and Practice in Oncology” is not a peer-reviewed journal, but this opinion piece was written by radiation oncologists from four major centers, Harvard, Duke and the University of Pennsylvania among them. The experts conclude that “a high quality comparison to other radiotherapy techniques has not yet been performed.”

They review data on dose distribution, apparent control rates and complications in drawing their opinions.

My take: The role of proton therapy is important as a research subject. It also has a role as best current treatment for certain rare tumors, including some that lie close to the base of the brain.

For now, I concur with the conclusion that “given the low rates of cancer-specific mortality in most men with non-metastatic prostate cancer, use of any form of radiotherapy would be expected to show similar survival outcomes as long as the most modern and appropriate techniques (and doses) are employed.”

3 Are antioxidants bad for you? Antioxidants have been promoted as health-promoting because oxidants, free radicals, can damage DNA.

Recall that DNA is a template for the materials that a cell produces and it is linked to cell proliferation. The Jan. 31 issue of Science has an article under the headline “Antioxidants Could Spur Tumors by Acting on Cancer Gene.”

The basis for treating with antioxidants was based on observations that people who eat more fruits and vegetables have lower rates of cancer. The observation doesn’t clearly extend to using supplements.

A recent trial of selenium and vitamin E to prevent prostate cancer was stopped when the vitamin E group showed an increase in those cancers.

An earlier study tested whether beta-carotene could protect smokers against lung cancer and found that the incidence of lung cancer increased.

A recently published study in Sweden uncovered a mechanism that may account for the unexpected results. Mice that are prone to develop lung cancer were fed only normal chow or a moderate supplemental dose of vitamin E. The vitamin-fed group developed more tumors and they proved to be faster growing ones.

Those mice showed less DNA damage, but the vitamin also turned down gene p53. The protein created by p53 exerts control on cell growth.

The authors point out that some studies seem to conflict with others. We can’t assume all antioxidants have the same effects.

My take: The government has limited ability to control claims of supplement promoters. If the FDA had more authority, it may not be able to more than warn us to be cautious.

I should look at the vitamin D issue one of these weeks.

My take, part II: When I squeeze into an airplane seat, I no longer tell the person next to me that I’m a physician. It almost always leads to a question about whether I think such-and-such is good for you.

Explaining that almost everything has multiple effects has become burdensome and bores the listener.

Now, I sometimes pull out my novel and promote it as something that couldn’t hurt them too badly.

4 The Jan. 17 Science has a report titled “Ammonia Pollution From Farming May Extract Hefty Health Costs.”

I know very little about the subject, but pass along the conclusions so I can stimulate arguments with farmer friends. Analyses indicate the adverse health effects from ammonia are worse than previous estimates.

Ammonia floats up from fields, manure and urine. When it mixes with sulfur and nitrogen oxides from autos and industry, they form tiny particulate matter that measures less than 2.5 microns and is highly toxic when inhaled. It is estimated that 5,100 people die prematurely from exposure.

The overall health costs are estimated at $100 per kilogram of ammonia, for a total of $36 billion in added cost.

“In contrast, the net value of the exported food is $23.5 billion,” the report says.

It has been suggested that livestock and dairy operations should be kept away from cities. Using manure for power generation and recapturing ammonia for fertilizer have attracted interest.

My take: I don’t know how accurate these estimates are, so I pass them along without further comment.

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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