I obviously cannot read every journal that comes out; I rely on JAMA to review important articles from disparate journals in the section “Clinical Trials Update” to stay as up to date as possible on non-gynecologic issues. This week, as I continued to recover from my own jet-lag induced insomnia, my attention was drawn to a review of a study that had been published in the journal “Stroke”. (Yes there are medical journals that specialize in just about every disorder.) The study was based on a review of claims data from 21,438 people with insomnia and 64,314 age and sex-matched controls in Taiwan. (I can’t help but do this; if it were a movie it would be called “Sleepless in Taiwan”!)

The researchers compared the two groups of participants for a period of four years. They found that the overall incidence of stroke was eight times higher among those who had been diagnosed as having insomnia between the ages of 18 and 34 when compared with controls who were without sleep problems. The risk seemed to become less with age, but in all age group, those with insomnia had a higher risk of stroke than those who slept well. Interestingly, women with insomnia had a 28% lower risk of stroke compared with insomniac men. (This may demonstrate that there are additional gender factors protecting our brains, perhaps our estrogen…)

The JAMA editors cite evidence to explain the study results. Insomnia can alter cardiovascular health by increasing inflammation, diminishing appropriate response to glucose (i.e. glucose intolerance), increasing blood pressure and causing increased activity of the sympathetic nervous system.

There are so many reasons to treat insomnia but now we have one more, especially in young adults. Medical research (and our own sense of alertness and well being) continues to demonstrate that a good night’s sleep is as important as our daytime behaviors for future healthspan and lifespan.

I quickly glanced at the first 2014 issue of JAMA before I returned to the office on January 2. And there was the first article to deal with weight… It was titled ” New obesity guidelines: promise and potential”. As we go back to our regular lives after the nutritional and alcohol excesses of the holiday, it seems most appropriate that we consider the major contributor to chronic disease: obesity. One in three US adults are obese.

There are new obesity guidelines to help physicians manage obesity more effectively. They were formed by an expert panel which first started their ponderous work in September 2008 and finally at the end of 2013 published what is now termed “Obesity 2″ guidelines for the management of overweight and obesity in adults. Here is a brief summary of their recommendations:

Recommendation 1 – Identifying patients who need to lose weight.

They continued to use BMI and waist circumference to identify those who are overweight or obese. An adult who has a BMI between 25 and 29.9 is considered overweight and an adult who has a BMI of 30 or higher is considered obese. Individual waist circumference is also important because abdominal fat is a predictor of risk for obesity-related diseases. If your waist circumference is more than 35 inches this adds to your risks from excessive weight. In general the greater the BMI and waist circumference, the greater the risk of cardiovascular disease, type 2 diabetes, and all-cause mortality.

Recommendation 2 – Counseling about the benefits of weight loss.

The panel stated that sustained weight loss of as little as 3 to 5% is likely to result in clinically meaningful reductions in levels of triglycerides, blood glucose, and hemoglobin A-1 C and in the risk of developing type 2 diabetes. Greater amounts of weight loss will reduce blood pressure, improve levels of low density and high density lipoprotein cholesterol, and reduce the need for medications to control blood pressure, blood glucose levels, and lipid levels as well as further reduce levels of triglycerides and blood glucose. The panel states that weight-loss can provide benefit for obese and overweight patients with only one additional risk factor and that one factor can simply be an increased weight circumference.

Recommendation 3 – Dietary therapy for weight loss.

The panel’s recommendations emphasize that there is no ideal diet for weight loss and that there is no evidence of superiority for any of the myriad diets they reviewed. Their primary recommendation is that a diet should achieve reduced caloric intake as part of a comprehensive lifestyle intervention (that includes exercise)

Recommendation 4 -Lifestyle intervention and counseling.

Obese or overweight individuals should enroll in comprehensive lifestyle interventions for weight-loss that should be delivered for six months or longer. The gold standard of therapy is on-site and high-intensity sessions (14 sessions or more in six months) provided in individual or groups by a trained interventionist. And further therapy should continue for a year or more. (They hope that payers will recognize the value of well-run programs that use this approach. They did state that lesser intensity approaches delivered electronically have not shown the same amount of weight loss and health benefits.)

Recommendation 5 – Bariatric surgery.

The Obesity 2 panel has advised practitioners to suggest to patients who are either obese with a BMI at or over 40 or at or over 35 with additional obesity related health conditions that they consider undergoing bariatric surgery by experienced bariatric surgeons.

Oy, this is a lot to consider for one third of our population. I was overwhelmed when I read this. I also lost my appetite for my next meal… But I thought I should share this with my patients and readers. Hopefully this will help to exhort all of us to maintain a lifestyle with appropriate caloric intake, and exercise in this new year.

This week I’m going to give a lecture at the annual conference of the Academy for Anti-Aging in Las Vegas. They asked me to give a talk months ago, and hey, a weekend in Vegas sounded great. I will report on the conference and my talk next week. When I power-pointed my talk, I included some general dietary recommendations and one was “Eat your nuts”. So when I saw the article in the November 21 issue of the The New England Journal of Medicine titled “Association of nut consumption with total and cause-specific mortality” I looked for new data to support this recommendation. And it was there…

The authors examined the association between nut consumption and subsequent mortality among 76,464 women in the Nurses Health Study (all woman) which was conducted between 1980 and 2010 as well as 42,498 men in the Health Professional Follow-up Study (all men) that went on between 1986 and 2010. (In other words, 30 years of study on a huge number of women and men.)

They found that for those who ate nuts as compared to those who did not there was a significant decrease in mortality during the 30 years of follow up. And this decrease in death rate was directly correlated with the number of times a week they ate nuts. Their risk of death was decreased by 7% with nut consumption once a week, 13% for 2 to 4 times a week, 15% for 5 to 6 times a week and a whopping 20% for those who ate nuts seven or more times a week. This inverse association was observed for most major causes of death, including heart disease, cancer and respiratory diseases. The results were similar for all tree nuts and peanuts. Not only that, the studies showed that the concern that frequent nut consumption can result in weight gain does not appear to be valid. In these two large studies, increased nut intake was associated with less weight gain and a decreased risk of obesity. So, how many nuts you should eat? In the study they considered a serving of nuts to be 28 grams or 1 ounce.

Why are nuts so healthy so healthy? They contain unsaturated fatty acids, high-quality protein, fiber, vitamins (folate, niacin and vitamin E), minerals (potassium, calcium and magnesium) as well as phytochemicals (flavonoids). These nutrients may have significant heart protective, cancer protective, anti-inflammatory and antioxidant properties.

Bottom line: I guess the advice to eat your nuts is appropriate. I’m off to eat eight almonds. (Yes, they are the salty kind.)

I’ve often written about exercise and its amazing impact on health. While I was in Tel Aviv, I made sure that I walked for a mile or two every day and even took several Pilates classes. The walking was both to avoid traffic and to see the beautiful beaches, the Pilates classes gave me the opportunity to compare this form of exercise in Israel to that which I do in LA. (Conclusion: the Pilates there was a bit more yoga-like and aerobic than that which I am used to… and I was probably the oldest one in the class.)

Upon my return this week, I was able to catch up on my JAMA journals and lo and behold there was a study about exercise and its impact on reduction of mortality from cardiovascular disease and diabetes. A metaepidimiological study (a descriptive word that my computer does not like, and frankly I had difficulty spelling) that examined a huge number of epidemiologic studies on exercise and medical therapies for chronic diseases was published online in October by the British Medical Journal and reviewed by the JAMA authors. They found that appropriately randomized trials have shown that exercise and drug interventions provide similar mortality benefits, especially for coronary heart disease and diabetes. Indeed exercise was more effective than drug treatment among patients recovering from stroke. Just so you have some numbers, the meta-analysis included 305 randomized controlled trials with 339,274 participants; however, only 57 of these trials representing 17,716 participants (still a significant number) closely examined the impact of exercise.

The researchers found that exercise interventions reduced mortality risk from coronary heart disease no less than statins, beta blockers, ACE inhibitors and antiplatelet medications. Exercise was significantly more effective than controls (no intervention or usual care) in reducing mortality risk among patients with stroke and actually outperformed anticoagulants and anti-platelet medication given to reduce risk of a second stroke.

The diehards (excuse the pun) would argue that more studies are necessary. The problem is that it’s difficult to design clinical trials that have the appropriate three arms of treatment in order to make final recommendations. They would have to include usual care, exercise training and separate drug therapy to see which worked. New trials are trying to do this. In the meantime it’s unlikely that your physician will say to you that you should exercise but don’t take your statin. On the other hand, for individuals who may be borderline for recommendations to receive medication, there’s now evidence that exercise may delay or prevent that need for medication.

Bottom line: We should all the exercises, especially if we are at risk for coronary heart disease, diabetes or stroke. And of course we should not forget that we have to establish good health behaviors (not smoking, weight control and appropriate screening). Remember we each have only one body that we can care for…

We know that colorectal cancer is the third most prevalent cause of cancer deaths in women. (In case you forgot the order, the first is lung cancer, and second, breast cancer.) My patients know that I routinely ask them on their visits if and when they had appropriate colorectal cancer screening; moreover I emphasize the fact that they should get a colonoscopy rather than a sigmoidoscopy. To put it simply and positionally, the latter just doesn’t go high enough and can miss polyps or cancer in the upper portion of the colon (This is termed the proximal colon…proximal to our upper body vs the distal portion which is quite literally near the rear.)

So here is one more study to support this recommendation… It appeared in the September 19 issue of The New England Journal of Medicine and was titled “Long-Term Colorectal-Cancer Incidence and Mortality after Lower Endoscopy”. The authors from Harvard Medical School, examined the association of the use of colonoscopy and sigmoidoscopy with colorectal cancer incidence and mortality among the the participants in the Nurses’ Health Study (all women) and the Health Professionals Follow-up Study (all men). The former included 121,700 US female nurses who were 30 to 55 years of age when they first enrolled in 1976; and the latter included 51,529 US male health professionals aged 42 to 75 years at enrollment in 1986. Sorry, I know I am touting a lot of numbers but basically, out of all these participants, 89,000 were followed in this study for over 22 years (a lot!). The researchers documented 1815 colorectal cancers and 474 deaths from this type of cancer. And what they found was that who had screening colonoscopy were 68% less likely to die from colorectal cancer and those who had screening sigmoidoscopy were 41% less likely to die. The reduced mortality from proximal colon cancer was nearly 50% after screening colonoscopy but not after sigmoidoscopy. And when the researchers looked at the length of time that colonoscopy was protective, they found that a negative colonoscopy was associated with a significantly reduced incidence of both distal and proximal colon cancer for up to 15 years after the procedure. In their discussion, they stated that “Our findings support the 10 year examination interval recommended by existing guidelines for persons at average risk who have a negative colonoscopy. Our studies (also) suggest that even a single negative colonoscopy is associated with a very low long-term risk of colorectal cancer. However, our data supports screening at more frequent intervals for persons with the family history of colorectal cancer.”

Bottom line: Get screened with colonoscopy starting at age 50 and if it’s negative you can repeat it with a good degree of confidence just every 10 years, provided there is no family history. Although sigmoidoscopy does reduce incidence and mortality from distal colorectal cancer, it does not do so for proximal colon cancer. So you might as well get the full colonoscopy. That proximal colon cancer you prevent may be your own!

We all want to believe in vitamins, especially antioxidants, hoping that they will help us live longer, prevent chronic illness, and like Popeye’s spinach, make us strong.

So when the latest JAMA published a clinical evidence synopsis from the Cochrane review about the power of antioxidants, I was intrigued. Just a reminder, the Cochrane Reviews are systemic reviews of research pertaining to human healthcare and health policy and are internationally recognized as the highest standard in evidence-based healthcare. They take a clinical question, review all the relevant studies and basically give us the bottom line after they have done an exhaustive statistical analysis.

So here is what they found in answer to the clinical question ” Are antioxidant supplements associated with a higher or lower all-cause mortality?”

They reviewed 78 randomized clinical trials which included 296,707 participants whose mean age was 63. And 46% of them were women (I wonder why not 50%, but let’s not go there). Of these, 26 of the studies where of individuals who were healthy and the remaining 54 trials assessed individuals with stable, chronic diseases that included coronary disease, diabetes, Alzheimer’s and age-related eye disease. All the antioxidants were given as oral supplements, either alone or in combination with other vitamins, minerals or other interventions. The mean duration of supplementation was three years. The reviewers then analyzed which of the studies were biased. ( An example of bias would be to ask someone who already has an illness if she or he took the antioxidant in order to prevent the illness.) They concluded that 82% of the participants had a low risk of bias. Obviously, when the low risk trials were analyzed separately from trials with a high risk of bias, the results were considered the most relevant. And here’s the surprising finding: “The antioxidant supplements were associated with a statistically significant higher all-cause mortality. The higher risk of all-cause mortality was observed for beta-carotene and vitamin E, and in some analyses for higher doses of vitamin A. Vitamin C and selenium were associated with neither higher nor lower all-cause mortality”.

We’ve all been hearing more and more about HPV infections; that they cause cervical cancer, vaginal cancer, anal cancer, throat cancer, mouth cancer and venereal warts. I’ve written several articles about the need to immunize girls and boys with the HPV vaccine. The most common vaccine, Gardasil is given in 3 doses, it is a quadravalent vaccine, which means it gives immunity to 4 types of HPV (6,11,16 and 18). These are the ones that cause 70% of cervical cancers, many of the other above mentioned cancers as well as venereal warts. But alas, despite the multiple direct to consumer ads in the media, recommendations by most doctors and the studies in peer-reviewed journals, only one third of adolescents are currently being immunized.

We would certainly expect the prevalence of these infections to be significantly diminished in those whose parents had the clinical acumen to have their children immunized. But they represent just 30% of their peers. So it was pleasantly surprising to find that a study published online in the Journal of Infectious Diseases reported that the prevalence of infections with the human papilloma virus types included in the Gardasil vaccine dropped by almost 60% among females aged 14 to 19 years during the four-year period after the vaccine became available and was recommended. Dr. Thomas Frieden, the CDC director, said during a press conference held to announce the results of the study, that increasing the vaccination rate to 80% would prevent about 50,000 cases of cervical cancer among girls alive today. “We owe it to the next generation- our sisters, our daughters, our nieces and to protect them against cervical cancer.”

Just to remind you, a three dose series of the quarivalent HPV vaccine was recommended in 2006 by the CDC as a routine vaccination for females age 11 to 12 years and for females aged 13 to 26 years who had not been previously vaccinated. In 2011, the recommendation for the vaccine was expanded to include boys aged 11 and 12 years and for non vaccinated males up to 26 years. No data is yet available on the proportion of males who have been vaccinated and/or the impact of vaccination on their infection rates.

The nearly 60% drop in HPV infection is greater than expected but can be due to “herd immunity” from vaccination (nothing to do with animals, it means that those who got the vaccination were unable to infect those who did not).

Remember, HPV is the most common STD in United States. The estimate is that 14 million people becoming infected with HPV every year. According to the CDC, 79 million of the those who have become infected with HPV are in their late teens and early 20s. Every year, about 19,000 cancers in women are caused by HPV; most are cervical cancer. And of 8,000 cancers caused by HPV that occur in men in the United States, most of them are oropharyngeal (mouth and throat).

Wow, this vaccine can make a huge difference. It may be too late for many of us who are over the age of 26 but we certainly can make sure that the younger (and youngest) generation are vaccinated… Not to do so is malparenting!

Imagine going through an entire pregnancy only to have your baby die at or within a month of birth. Nor do we expect to lose our lives during childbirth. Most American women would say that this is a tragic scenario that is far more likely to occur in developing countries. That’s correct, but a new report issued by Save the Children for Mother’s Day gives us pause for concern about our self satisfaction regarding our country’s maternal, newborn and child safety status. But before I report on America’s less than stellar statistics, let me give you some global ones:

Every year, nearly 7,000,000 children die before the age of five.
Every year, 40 million women give birth at home without the help of the skills birth attendant.
Every day, 100 women died during pregnancy or childbirth and 8,000 newborn babies die during the first month of life.
Newborn death accounts for 43% of all deaths among children under age 5.
3 million newborn babies die every year – mostly due to easily preventable or treatable causes such as infections, complications at birth and complications of prematurity.
60% of the infant deaths occur in the first months of life. Among those, nearly 3/4 die in their first week. And more than a third die on the date of birth.

Save the Children has compiled a yearly mother’s index that uses five indicators, definitions and data sources in order to rate the well-being of mothers and their children. These include: Lifetime risk of maternal death, under-five mortality rate, expected number of years of formal schooling, gross national income per capita and finally participation of women in national government. Now as underwhelming as this may be, our country ranks 30th on this mother’s index. Overall, the US performs quite well on educational and economic status (10th best in the world) but it lacks behind all other top ranked countries on maternal health (46th in the world) and children’s well-being (41st in the world) and performs poorly in political status (89th in the world!) And here is why:

In the US, women face a 1 in 2,400 risk of maternal death. Only five developing countries in the world – Albania, Latvia, Moldova, the Russian Federation and Ukraine – perform worse than in the United States on this indicator. A woman in the US is more than 10 times as likely as a woman in Estonia, Greece or Singapore to eventually die from a pregnancy related cause.
In the US, the under five mortality rate is 7..5 per 1,000 life births. This is roughly the same as the rates in Bosnia and Herzegovina, Qatar and Slovakia. At this rate, children in the US are three times as likely as children in Iceland to die before their fifth birthday.
Women hold only 18% of seats in the United States Congress. Half of all countries in the world perform better on this indicator. Sixteen countries have more than doubled this percentage of seats occupied by women. In Finland and Sweden, for example, women hold 43 and 45% of parliamentary seats respectively.

So who ranks first? Finland wins, followed by Iceland and the Netherlands and then Denmark. Ahead of us in the mother’s index is Estonia, followed by Canada, United Kingdom, Czech Republic, Israel, Belarus, Lithuania, Poland and Luxembourg. Then and only then we follow. The worst countries for mothers and their children are in sub-Saharan Africa and include Niger, Mali, Sierra Leone; last on the mother’s index is the Democratic Republic of the Congo.

Most of my patients, as well as readers of my website, know that I’m very involved with Save the Children and indeed serve as a trustee. I am particularly proud of our global newborn and child survival campaign. We are currently working on four fronts:

  • Increasing the awareness of the challenges and solutions to maternal, newborn and child survival. (as part of the campaign Save put out this year’s state of the world mothers report.
  • Encouraging action by mobilizing citizens around the world to support programs to reduce maternal, newborn and child mortality.
  • Working in partnership with national health ministries and local organizations and are supporting efforts to deliver high quality health services throughout the developing world. This means improving pregnancy and delivery care, vaccinating children, treating diarrhea, pneumonia and malaria as well as improving nutrition
  • The program Saving Newborn Lives launched in 2000 with the grant from Bill and Melinda Gates Foundation has helped deliver better care practices and improve health interventions to save newborn lives in 18 countries.At home we, the concerned women (and men) can help. Our votes and letters can have a huge impact…Congress should create a national commission on children to address the needs of 16 million children in the US now living in extreme poverty. Congress should also protect US global health funding and increase support for maternal and child health and nutrition. If every woman is afforded appropriate maternal health care (and hopefully the new health laws that go in effect in 2014 will help ensure this), we need not be ranked 30th in the world.

    So now I will do my trustee thing….If you want to learn more or help us make a difference in the lives of millions of children please go to www.savethechildren.org/newborn-action.

As I read the current medical journals, I have to make use of a new “library” of terms that refer to our bodies’ genes, RNA messengers, proteins and enzymes, not to mention the generic names of the drugs meant to impact the molecular basis of disease. But as medical knowledge becomes more “micro,” we can’t discount the macro…the need for individuals to get basic screening, diagnosis and therapy of common disorders. There is no requirement for medical ten-dollar words to understand the recent “Vital Signs” article in JAMA. It was a report by the National Center for Health Statistics at the CDC, documenting the prevalence, treatment and control of hypertension in the United States.  Here are some of the stats that they reported, which could on their own make ones blood pressure go up by at least a few points. (I’m talking systolic here…)

  • Every year, hypertension contributes to one out of seven deaths in the U.S. and tonearly half of all cardiovascular disease-related deaths (heart attack and stroke).Hypertension affects an estimated 68 million U.S. adults.
  • If all individuals received adequate treatment for their hypertension, 46,000 deaths might be averted each year.
  • Direct and indirect costs of hypertension are more than $93.5 billion per year
  • Cardiovascular disease and stroke account for 17% of total health expenditures in the US annually
  • Overall U.S prevalence of hypertension among adults after the age of 18 between 2005 and 2008 was 30.9% (and highest among persons at or older than 65). This prevalence has remained unchanged during the past 10 years.
  • 30% of patients with hypertension are not being treated pharmacologically.
  • Only 45.8% of those with hypertension have their blood pressure adequately controlled.

There are, of course, recommendations as to what should be done to deal with this pervasive disorder and the resultant disease. Blood pressure readings should be taken seriously (and regularly). Anyone who has a blood pressure that is 140/90 needs to consider medication and lifestyle changes. Physicians now think that blood pressure reductions below the threshold for clinical hypertension (115/75) can have health benefits over time. An analysis of over 61 prospective observational studies of blood pressure and mortality (you know the ones that follow large groups of individuals for years) have shown that for each 20 mmHG increase in usual systolic blood pressure (This is the top number in blood pressure readings and represents the pressure that your heart is exerting to get the blood to flow through your arteries) or 10mmHG increase in usual diastolic blood pressure (which represents the pressure of the vessels between heart beats) above 115/75 mmHG was associated with a doubling in stroke mortality and death from heart attack at ages 40 to 69.

Before I sound the “get thee medicated” alarm, let’s go over the behavioral changes that can impact blood pressure. They should be adopted by all of us. (I’m sure we all know them, but since the American Heart Association has made them official here they are: (1) achieving and maintaining a healthy body weight; (2) participating in regular leisure-time physical activity (and I don’t think shopping counts, unless you have to walk rapidly for a total of 30 minutes from store to store to car.) (3) adoption of a healthy diet, including reducing salt intake and increasing potassium intake; (4) smoking cessation; and (5) stress management) Note, the AHA gave no indication in this report as to how to do this and I’m not going to begin to tackle stress reduction  in this “brief” newsletter. It would require a treatise in philosophy, psychology, economics and the 24-hour news cycle!

There are, of course, multiple pharmacologic therapies and frequently more than one is needed to achieve adequate blood pressure control. That’s where a physician’s knowledge and choices of medication are needed (as well as health insurance to help pay for access to the physician, appropriate follow-up and purchase of the medications… According to this CDC report, one of the groups with the lowest prevalence of blood pressure control consists of individuals without health insurance.)

Molecular biology may help us understand the whys, wherefores and potential treatments of disease. But unless we self-maintain our own health by eating right, moving our derrieres off the chair (I guess you should get off your computer, iPad or Blackberry where you are currently reading this admonition), adhere to prescribed medication and improve access to care, that “one in seven” (deaths due to hypertension) will continue.

Bottom line: Make sure your blood pressure is checked regularly and if elevated, even “a bit” (over 115/75) work on your lifestyle. If 140/90 or over, check with your physician as to your need for medication and adhere to whatever is prescribed. The pressures of life (and death) start with your own!

I know we have all heard the admonitions not to text or use hand-held cell phones while driving. Oprah even wrote an editorial in the New York Times. I installed a hands free device in my car several years ago in order to comply with California laws as well as to assume my role in assuring road safety to those in my car (mostly my dog) as well as on the road. A commentary in the April 15th issue of JAMA caught my attention and pointed out my inattention to the statistics that warn that even hands free devices result in accidents.

So here are the distracting statistics:

  • 5,870 persons died (16% of all fatalities) in crashes involving driver distraction due to texting or use of mobile phones in 2009
  • 515,000 individuals were injured in what are now called “distracted crashes”.
  • 21% of all reported injury crashes involved distracted driving
  • While dialing a mobile phone, drivers of light vehicles (cars, vans and pickup trucks) were 2.8 times more likely to crash or near crash than non-distracted drivers. (If they were commercial truck drivers this number rose to 5.9.)
  • Texting is a disaster waiting to happen….the average person who texts while driving takes her eyes off the road for 4.6 to 6 seconds and is 23.2 times as likely to have a serious vehicular crash compared to a non-texting driver.

And here is what really got my attention:

Analysis of 125 studies confirmed that cell phone conversations while driving were associated with impaired reaction time and that there was NO difference in risk between hands-free and handheld phones! And according to the Highway Loss Data Institute (yes there is an institute for everything) the benefits of banning the use of hand-free phones are outweighed by the increased use of similarly distracting hands-free devices. They found no decrease in crashes in states that enacted handheld cellular phone bans when compared to states that did not.

As I and my family update our cars, we are bestowed with more and more electronic gadgets. I can now do everything but write this column while driving… but I guess I won’t try. The good news is that using a GPS (with verbal instructions) is safer than trying to read a map. So I can tell my husband (who always gets lost) that his GPS is relatively safe. But the bad news is that I will not try to save time and answer patient queries while driving but instead will instruct you to call back once I have reached my destination.

Our cars should be declared no phone or messaging zones. For your sake, mine and all the other drivers and pedestrians on the road, I hope you will consider the above stats and turn your i-phones, blackberries, droids and i-pads off while driving.

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