Early last month, the American Academy of Family Physicians (AAFP) launched a "Consumer Alliance" corporate partnership program. Through the program, corporations are being offered the opportunity to, as the AAFP press release put it, work with the academy “to develop educational materials to help consumers make informed decisions so they can include the products they love in a balanced diet and healthy lifestyle."

The first corporate partner to sign on (with a reported one-year, six-figure grant to AAFP) was Coca-Cola.

I’m still trying to wrap my mind around the idea that Coca-Cola’s sodas can have a positive role in a healthy lifestyle.

For, as Harvard University epidemiologist and nutrition expert Dr. Walter Willett told the Associated Press on Thursday (hat tip, Schwitzer Health News Blog), "Coca-Cola, like other sodas, causes enormous suffering and premature death by increasing the risks of obesity, diabetes, heart attacks, gout, and cavities."

Is Coca-Cola going to be happy if that kind of message goes up on AAFP’s consumer health and wellness website? I don’t think so.

It’s much more likely the health warnings about sodas will get watered down on the AAFP website. And, let’s face it, that’s probably the outcome Coca-Cola is hoping for.

AAFP’s CEO, Dr. Douglas Henley, has said that Coca-Cola won’t have any influence over the academy’s health messages. The website will, he promised, include information about the association between soda consumption and obesity and will emphasize sugar-free alternatives.

But research has linked sugar-free as well as sugary soft drinks to an increased risk of metabolic syndrome, a group of risk factors associated with the development of diabetes and cardiovascular disease.

Will that negative information about sugar-free soft drinks also be highlighted on the website?

Mimicking the tobacco industry?

The announcement of the alliance with Coca-Cola has caused a mini-mutiny among some of AAFP's 94,000-plus (physicians and medical students) members. Led by a group of family physicians in the San Francisco area, a small number of members have resigned in protest.

“Having the soda industry create materials about making the right choices is like having the fox guard the hen house,” one of the San Francisco doctors who resigned said in a press release. “This is reminiscent of when the tobacco industry enlisted doctors to endorse cigarette brands as ‘mild.’”

A national petition drive of “Family Doctors Against the AAFP-Coca-Cola Partnership” has now been launched. As of this morning, it had 77 signatures, including one Minnesota physician, Dr. Michael Schoenleber of Roseville, who signed it Thursday.

“I can not believe you [AAFP] did this,” Schoenleber wrote on the petition. “You have made fools of your members. I am renouncing my membership from AAFP after 25 years.

UPDATE: I was able to talk with Dr. Schoenleber on the phone. He says he was "pretty livid" when he first learned about AAFP's alliance with Coca-Cola. The pediatrician who brought the issue to his attention "thought it was a joke," he says.

Schoenleber, who practices at HealthPartners Arden Hills Clinic has been studying metabolic and nutritional medicine and says he now advises everybody he knows not to drink sodas. In addition to the link with metabolic syndrome, sodas "cause calcium to be leached out of your bone," he says. "You end up more likely to develop osteoporosis and fractures later in life."

"Any professional academy I'm associated with can't be in bed with someone who creates something that I think is a poison," Schoenleber says.

No local mutiny

Yesterday, I spoke with Dr. Patricia Fontaine, president of the AAFP’s local chapter, the Minnesota Academy of Family Physicians. At that time, she was unaware of any Minnesota members who had resigned because of this issue.

“We haven’t had any calls,” she said.

Fontaine was also quick to point out that the decision about the alliance was made at the board level. “Chapters weren’t really involved,” she said.

Fontaine said she sees both sides of the issue. 

“On the one side,” she said, “the academy is making it very clear that they’re not endorsing any specific Coca-Cola products. On the other side, there is the appearance of an endorsement, and, as physicians, we all know there are problems with sweetened soft drinks being probably the number one source of sugar in the diet.”

“There are even some studies that suggest that artificially sweetened beverages may have some downsides,” she added.

Fontaine said, however, that  it would be “irresponsible” for her to drop her membership over this issue, for that would be making the controversy seem larger than it really is.

The content on the website is slated to appear in January,  Fontaine noted, and AAFP officials have said they’ll retain total editorial control of the information that's presented.

“Until that content appears, I’m going to give [AAFP] the benefit of the doubt,” she said. 

In the meantime, the Associated Press reports that the AAFP Foundation, a separate philanthropic group, has accepted financial support from “drug companies, McDonalds, PepsiCo and a beef industry group” and “is in talks with other foundation contributors to fund other materials” for the AAFP.

Are health consumers to believe that those materials also won’t be watered down? Sounds like the floodgate is already open.

Recently, Disney announced that it would refund parents for Baby Einstein DVDs — you know, the ones aimed at the under-2 set and whose creator was praised and feted by Oprah and President George W. Bush alike.

The company vehemently denies, however, that this action is a tacit acknowledgement that it ever misled parents into believing the DVDs would make their babies smart — or even into thinking that they’re educational.

Hmmm …. I guess branding the products with the “Einstein” name is … what? A coincidence?  And then there’s the initial claim — admittedly no longer made by Disney, but out there in the zeitgeist nevertheless — that the Baby Einstein DVDs “have roots in important cognitive research” and can “facilitate the development of the brain in infants ages one through 12 months.”

Actually, research suggests the opposite. For example, a 2007 study involving children (some in Minnesota) aged 8 to 16 months found that for every hour a child spent watching a Baby Einstein or other type of baby-oriented DVD or video, the child understood six to eight fewer words than same-aged babies who didn’t watch them.

Other research has found that children who start watching TV before they’re a year old and who watch it for more than two hours a day are about six times more likely to have language delays.

TV and children’s aggression
Then there’s the study released this month in the Archives of Pediatrics & Adolescent Medicine that found an association between TV exposure and aggression in young children.

Again, for every hour of either direct or indirect daily TV viewing, 3-year-olds displayed a slight but statistically significant increase in aggressive behavior. And this association held even when the researchers controlled for other factors known to increase children’s aggression, such as living in an unsafe neighborhood, having a mother who’s depressed, or being spanked.

(The study has its limitations — most notably, the mothers self-reported their households' TV habits. Self-reporting is, obviously, an unreliable means of gathering data.)

But, parents, don’t think that this study isn’t about you and your child just because you restrict your child’s TV viewing to nonviolent shows.

“Without knowing the content of the programs viewed, we cannot say for certain whether it is violent TV content that causes children to behave more aggressively, as there is a lot of nonviolent educational content available on TV, which may be beneficial to children and is unlikely to lead to aggressive behavior,” wrote the study’s authors. “Yet even when children are primarily watching such programming, they may be exposed to violence through TV commercials or even G-rated movies according to findings from prior research.”

In any event, what your child watches on TV isn't the only thing you should be focusing on. Your television habits are also part of the problem.

“A recent study found that background TV negatively affects the quantity and quality of interactions between parents and children, and TV viewing by young children is characterized by less frequent interactions with parents,” the researchers pointed out. “Parents who are focused on TV programs may pay less attention to their children, be less engaged in play, and/or may react negatively toward the children if their TV viewing is interrupted.”

Parents in denial
Many people are in denial about the effects of TV — particularly violent TV — on their children’s and on their own behavior, notes Michael Potegal, PhD, an associate professor of pediatrics and neurology at the University of Minnesota.

“There’s an enormous amount of data collected over the years that shows quite conclusively that exposure to violent media increases the propensity for thinking about aggression and being aggressive,” he says.

Yet most people claim such data has nothing to do with them.

“Part of the reason, to put the nicest face on it,” says Potegal, “is that it’s not immediately obvious to people involved in these situations that it’s happening to them. They’ll say things like, ‘I play violent video games and I haven’t killed anybody.’”

But the effects of violent media are much more subtle, says Potegal.

“If you do close histories of those people and look at the arguments and fights they’ve gotten into, you’d see some effect. It’s under the surface, though,” he says.

What should parents do? “Turn off the TV and get the kids involved in other activities, particularly physical activities,” says Potegal. “And when they’re watching TV, have them watch less violent activities.”

The American Academy of Pediatrics recommends no more than two hours of media time daily for children aged 3 and older. And the recommendation for younger children? No media at all.

Time to wave bye-bye to Baby Einstein.

Finally, perhaps, women are getting the news that breast-cancer screening carries risks as well as benefits and that the decision to undergo screening requires a more nuanced approach than the current one-size-fits-all recommendation that all women, starting at age 40, should have an annual mammogram.

An article in Tuesday's New York Times goes a long way to explaining why that recommendation oversimplifies the matter  — and to introducing women, who may not have realized it until now, to the fact that cancers experts do not agree on what the evidence actually says (or doesn't say) about the risks and benefits of mammography screening. Indeed, many experts believe the benefits have been exaggerated.

Reading the article won't make your decision about screening easier, but it will make that decision more informed.

Writes reporter Denise Grady:

The general themes from the differing — and often impassioned — views of the experts interviewed by Grady might be summarized as follows (but, please, read the entire Times article to come to your own conclusion):

• There remains much debate about whether all women aged 40 to 50 (not just those at high risk of developing breast cancer) benefit from regular screening. The evidence supporting annual screening for this age group is, at best, very weak.

• There’s more of a consensus (but one that is by no means universal) that women between the ages of 50 and 70 may benefit from screening. But are yearly mammograms necessary? As Grady’s article points out, European women in this age group tend to be screened only every other year, and their breast-cancer death rates are the same as in the United States.

• The evidence that suggests women over 70 benefit from screening is, again, weak, at best.

Grady concludes her article by sharing how her reporting on this issue has informed her personal decision regarding mammograms:

Whether there is a psychological disorder that could be called (for lack of a better term) “Internet addiction” is a hotly debated question in the medical community.

In Monday’s Boston Globe, we get yet another exploration of the topic by reporter Elizabeth Cooney. Her article doesn’t come to any conclusion, but it does raise the usual questions about this perplexing and yet-unresolved issue.

“In a world where always being connected seems as vital as breathing, how much is too much?” Cooney asks. “And does excessive Internet use equal addiction?”

One of the experts she quotes doesn’t like the addiction label, preferring instead the more understated term “problematic use of electronic media”:

The evidence seems to be pointing in the direction of some kind of pathology. Reports Cooney:

“Internet addiction” is not in the current Diagnostic and Statistical Manual of Mental Disorders (the psychiatrist’s “bible” of diagnoses), but its inclusion is being considered for the next edition.

Should it be? 

(If you want to determine if you're too obsessed with the Internet, the Globe article includes a "11 Signs of Internet Addiction" questionnaire, developed by the Seattle-based ReSTART center for Internet addiction.) 

You may have gained an hour over the weekend as we ditched daylight saving time for standard time.

But do you feel more rested?

In theory, you should. After all, you had an extra 60 minutes this morning to get your act together before heading out to work (if you still have a job in this recession, that is). And, if you had wanted to, you could have spent that hour asleep under your comforter, reliving in your dreams the Minnesota Vikings’ great victory yesterday. 

But a small Finnish study published late last year came to an interesting conclusion about the transition out of (in the fall) and into (in the spring) daylight saving time. 

It found that the fall transition was more difficult for morning-type people. Those are the people whose internal biological clocks, including the ones that determine alertness, rev up early in the morning. You know — the people (mea culpa) who are annoyingly chipper at the breakfast table, even without a cup of coffee. 

This finding surprised the study’s authors, as standard time contributes a bonus hour of light to the mornings — the period of the day so beloved by morning people. 

Almost all the participants in the Finnish study — morning and evening people alike — slept less efficiently in the days after the fall time change than after the spring change. (Sleep efficiency = actual sleep time divided by time in bed.) Their sleep was, on average, 54 percent more fragmented and disrupted in the fall compared to 37 percent in the spring. 

But it was the morning people who seemed to feel the effects of that fragmented sleep. 

Of course, evening-type people (those who mumble their way through breakfast but who are wide-eyed at midnight) have their own time-adjustment struggles. But their nemesis is the hour they lose in the spring, when we switch back to daylight saving time. In fact, their biological clocks may never truly adapt to the change. 

A final note: Last year, a Swedish study found a small association between heart attacks and our twice-yearly time shifts. Heart attacks increased for the first three weekdays after the transition to daylight saving time in the spring, but only for one day after the change to standard time in the fall. 

Um, that one day is today. 

So take it easy. And for all you morning people who are feeling a bit sluggish today: Try an extra cup of coffee this morning.

I’m embarrassed to admit it, but while driving in the U.K. last week, I scraped some paint off my rental car. I misjudged how far away I was from an iron railing.

I have a host of excuses: It was late at night. I was returning from dinner at the home of relatives, who live on a very, very dark lane. I was turning onto a ridiculously narrow single-lane bridge at an equally ridiculously awkward angle — and while climbing a small hill. I was driving a stick shift (something I normally don’t do). And, of course, I was sitting on the right side of the car, so judging distances on the left was a bit challenging.

I could yatter on (as they say in Britain) with more excuses, but, hey, I may not need to.

My best excuse might be in my genes. According to a study published recently in the journal Cerebral Cortex, up to 30 percent of Americans have a gene variant that may make them lousy drivers.

The variant can be found in a gene that produces brain-derived neurotrophic factor (BDNF), a protein that helps brain cells communicate with each other and that serves a vital role in memory and learning. Earlier research has found that people with the variant tend to release smaller amounts of BDNF when they’re trying to learn a new task that requires physical coordination.

Staying on track

For the current study, neuroscientists at the University of California, Irvine, asked 29 people (22 without the gene variant and 7 with it) to drive 15 laps using a driving simulator. Participants were asked to keep their “car” on a black-lined track in the center of a curving road. Four days later, they returned to perform the task again.

The people with the gene variant performed more than 20 percent worse on this task than their non-variant counterparts. Both groups did better the second time around — but those with the gene variant still made more errors than those without it.

Of course, this study, like all studies, has limitations. It was small and involved people in a narrow age range (18 to 30 years old). And unobserved factors, such as the participants' mood and anxiety levels, may have affected the outcome.

Helping stroke victims

Despite the fact that it involved a driving test, the purpose of this study wasn’t to figure out some genetic way of dividing people into “good” and “bad” drivers. (And let’s hope some insurance company doesn’t use the study’s findings for that purpose.) The study’s intent, say its authors, was to shed more light on how the brain can relearn complex tasks after an injury, such as a stroke.

And, indeed, previous research suggests that people with this gene variant have more difficulty recovering from stroke.

Nor is the news all bad for people with the variant. It turns out they’re also less vulnerable to certain neurodegenerative conditions, such as Parkinson’s disease, Huntington’s disease and multiple sclerosis. (This factor may explain the evolutionary staying power of the variant.)

I have no idea if I have this gene variant or not (and I’m not sure I want to know).

What I do know, however, is that I’m not going to attempt to drive over that bloody bridge again at night.

Maybe we’ll finally see an end to those misleading labels on breakfast cereals (and other processed foods).

Last week, the Food and Drug Administration (FDA) announced that it had begun a long-overdue analysis of nutritional claims on food labels to determine if any of them are misleading and thus violate federal food labeling rules. The FDA also said it intended to develop new science-based standards for front-of-the-package nutrition labeling.

Almost immediately, Kellogg, Kraft, Minnesota-headquartered General Mills and 11 other food companies announced they were voluntarily suspending their Smart Choices food-labeling program. That’s the program, introduced last August, that uses green labels on the front of packages to let us harried and oh-so-gullible consumers think that some processed foods are healthier than others.

No matter that the label could be found on Fruit Loops, Cocoa Puffs, Fudgesicles and other products that may contain up to 50 percent sugar and/or up to 80 percent of the recommended daily dietary fat allowance!

According to Forbes magazine, the food companies spent $1.47 million to develop this highly dubious marketing ploy.

Bad habits are hard to break, however. If you’ve hiked down your local grocery store’s cereal aisle lately, you may have noticed the breathless new banner plastered (in very large font) across the front of the sugary, chocolate-laden cereal Cocoa Krispies:

“Now Helps Support Your Child’s Immunity.”

I wasn’t the only person to think this label was a cynical attempt to cash in on parents’ worries this fall about the H1N1 (swine flu) virus. On Tuesday, San Francisco’s city attorney, Dennis Herrera, sent off a sharply worded letter to Kellogg’s CEO, David Mackay, asking for the scientific evidence behind the immunity claim.

“The Immunity Claims may falsely suggest to parents that cereals like Cocoa Krispies are more healthy for their children than other breakfast foods that are not high in sugar and not highly processed,” the letter noted. “The Immunity Claims may also mislead parents into believing that serving this sugary cereal will actually boost their child’s immunity, leaving parents less likely to take more productive steps to protect their children’s health.”

Of course, by the time the matter is resolved and the label is taken off cereal boxes (undoubtedly “voluntarily”), the flu season will be over — and Kellogg and the other food companies will be dreaming up questionable product claims for next year.

Let’s hope the FDA finally puts some teeth into its food labeling rules. 

In Tuesday's New York Times, evolutionary biologist Olivia Judson asked the provocative question:

“Do some languages contain an intrinsic bias towards pulling happy faces? In other words, do some languages predispose – in a subtle way – their speakers to be merrier than the speakers of other languages?”

Judson said she was able to track down only this “smidgen of evidence to suggest the idea’s not crazy”:

Judson would like to see researchers test her hypothesis. In the meantime, you can be a study cohort of one: Try smiling more today. See if it changes your mood.

Metaphorically speaking
On a (sort of) related topic, BBC radio ran a short segment Tuesday (accompanied by a written article) on how the metaphors used by doctors and other medical professionals may influence a patient’s ability to endure a medical treatment.

The segment also suggests that a doctor’s choice of metaphor may even influence a patient’s decision to undergo a particular treatment:

As Brown doesn’t present any studies to support his “nine out of 10” patients statistic, I'm going to remain skeptical about that claim. (And his mode of therapy -- Human Givens -- apparently has a poor record of backing up its claims with empirical evidence.) But it’s certainly not unreasonable to assume that how a physician frames a patient’s treatment options (whether or not that framing involves metaphors) will influence the patient’s decision-making process.

If you want to catch the 25-minute-long BBC audio segment, "Metaphor for Healing," you can do so here. (You have six more days to listen to it.)

For a highly readable and eye-opening article on the anti-vaccination movement, I recommend freelance writer Amy Wallace’s “An Epidemic of Fear: How Panicked Parents Skipping Shots Endangers Us All,” published last week in Wired magazine.

The article explains why other people’s decision to opt out of vaccinations for their children puts you and your family at risk — yes, even if your family has been fully vaccinated.

Here’s why you should care: Wallace describes how an Indiana teenager contracted measles in 2005 while visiting Bucharest, Romania, and then quickly spread the illness as soon as she got home — including to 34 of the 500 or so people present at a church gathering she attended the next day. Most of those who caught the illness (32) had not been vaccinated against measles. But two had.

“The frightening implications of this kind of anecdote were illustrated by a 2002 study published in The Journal of Infectious Diseases,” Wallace writes. “Looking at 3,292 cases of measles in the Netherlands, the study found that the risk of contracting the disease was lower if you were completely unvaccinated and living in a highly vaccinated community than if you were completely vaccinated and living in a relatively unvaccinated community. Why? Because vaccines don’t always take. What does that mean? You can’t minimize your individual risk unless your herd, your friends and neighbors, also buy in.”

More and more parents, Wallace writes, are acting out of fear and electing not to have their children vaccinated:

(Minnesota is also one of those “opt-out” states.)

UPDATE: I asked Buddy Ferguson, public information officer for the Minnesota Department of Health, if there has been any noticeable change in the percentage of parents declining vaccination for their school-aged children in recent years. Specific numbers are difficult to come up with, he said, but "over the last several years, [the state has] seen some decline in immunization rates among children in Minnesota schools." The percentage of children not immunized is still under 5 percent, he added.

The persistence of pseudo-science
Wallace does a good job of explaining how “well-intentioned people … motivated by love for their kids” have become vulnerable to the pseudo-science behind the anti-immunization movement:

But rational thinking seems to have escaped many in the anti-vaccination movement.

For example, as Wallace outlines in her article, they vilify and even physically threaten Paul Offit, a Philadelphia pediatrician and advocate for mandatory vaccines, for “being in the pocket” of big Pharma because he receives a royalty from a vaccine he co-invented for rotavirus gastroenteritis, the most common form of severe and often life-threatening diarrhea in children. (Public health experts estimate that 600,000 children, including around 40 in the United States, die from this illness each year.)

Yet those same anti-vaccination crusaders welcome with open arms to their conferences a doctor and supplement salesman who proclaims to parents (without any empirical evidence): “No vaccines + more vitamin D = no autism.”

As Wallace writes, “If only it were that simple.”

When I arrived in Great Britain last week, the most talked-about health topic in the British press concerned fathers-to-be.

Should they or shouldn’t they be in the delivery room?

It was a discussion that seemed oh-so-1970s. But then Britain has always seemed to me behind America in terms of letting go of long-ingrained gender roles.

The firestorm began when Dr. Michel Odent, the well known (in Britain) French-born but longtime London-living obstetrician, proclaimed his belief that men — fathers and physicians alike — should stay away during the birthing process.

"The ideal birth environment involves no men in general,” the 79-year-old Odent told a reporter. “Having been involved for more than 50 years in childbirths in homes and hospitals in France, England and Africa, the best environment I know for an easy birth is when there is nobody around the woman in labor apart from a silent, low-profile and experienced midwife – and no doctor and no husband, nobody else. In this situation, more often than not, the birth is easier and faster than what happens when there are other people around, especially male figures – husbands and doctors."

Here’s Odent’s reasoning: The presence of a male in the delivery room causes women to become tense, which slows down their production during labor of the hormone oxytocin.

“If she can’t release oxytocin she can’t have effective contractions, and everything becomes more difficult,” Odent said. “Labor becomes longer, more painful and more difficult because the hormonal balance in the woman is disturbed by the environment that’s not appropriate because of the presence of the man.” He blames this “masculinization of the birth environment” for the recent rise in Caesarean sections in the U.K. (Almost one-quarter of all births in the U.K. are by Caesarean section. In the United States, the rate is even higher — about 31 percent.)

The idea that the mere presence of a man in the delivery room slows down oxytocin production is a provocative theory, but Odent doesn’t cite any research to back it up. Nor could I find any in a quick search of Pubmed.

Still, there is some research that suggests the presence of a supportive woman (a doula) in the delivery room along with a male partner can have both psychological and physical benefits for the mother — even, perhaps, lowering the likelihood of Cesarean section.

I personally hope we're not going to go back to the Dick Van Dyke Show days when bumbling (as they were inevitably portrayed) fathers-to-be were relegated to hospital waiting rooms instead of participating in one of the most transformative moments of their lives — the birth of their child.

That said, not all fathers should be allowed in the delivery room. Case in point: the drunk 30-year-old dad-to-be who two weeks ago groped a nurse’s breasts as she wheeled his wife into the delivery room in a Utah hospital.

That father was quickly carted off to jail. "Obviously," noted a police officer with dry understatement, "he wasn't there for the birth of the child."