Keith Roach, M.D.

Dear Dr. Roach:

My brother-in-law is a lovely man, but for years, he’s suffered from obesity. He also gambles and drinks alcohol too much. I hesitate to get too involved, but I recently read that the new weight-loss drugs based on GLP-1 agonists are also helpful in reducing alcohol and gambling addictions. This sounds too good to be true. Is it? — D.N.A.

Answer:

The evidence is very strong that GLP-1 agonists like tirzepatide (Zepbound) and semaglutide (Wegovy) help people lose weight. About 80% to 90% of people will experience a weight loss of more than 5% of their initial body weight. For people who are severely obese, people with obesity and metabolic complications (diabetes, prediabetes or metabolic syndrome), and people with other weight-related complications (sleep apnea and arthritis), the benefits of these medicines probably outweigh the risks just for the weight loss.

The evidence for GLP-1 agonists helping with alcohol use disorder is now quite strong, with studies showing significant reductions in alcohol-related hospitalizations and a reduction in problem drinking. The evidence for gambling disorders is preliminary based on the understanding of how these drugs work in the brain. There is no strong clinical data at this time supporting the use of GLP-1 agonists for a gambling disorder.

Still, given the clear benefits in weight reduction and problem drinking, these drugs might be a good choice for your brother-in-law — if both he and his physician agree. It might also help his gambling problem, which I’ve seen take a terrible toll on a person’s social and financial life.

Finally, I was supervising a medical resident yesterday when we discussed the effect of these drugs on heart health. The evidence is also strong that these medications decrease the risk of heart disease — both in people with and without diabetes. Multiple mechanisms have been proposed for this heart protection, but it isn’t exactly clear which ones are the most important.

For those of us who lived through the approval of previous weight-loss drugs, which were later found to cause heart damage, the news about heart protection is welcome. Still, we’ve been using these drugs for less than 10 years, and it’s wise to use them only when there is a clear benefit in doing so.

Dear Dr. Roach:

What are the long-term health risks of being exposed to fumes, such as in a hair or nail salon or automobile repair shops? Can these fumes affect your internal organs? — C.R.C.

Answer:

The primary organ affected by fumes during occupational exposure are the lungs. Chest tightness, wheezing and allergic symptoms are common after exposure to benzene, formaldehyde, toluene and other substances that are commonly used in hair and nail salons — often at levels that exceed the safe thresholds. Half of technicians in one study were affected.

Auto body and paint workers are also exposed to the same (or very similar) chemicals, and they can develop asthma at a rate that is 80 times higher than the general population. In addition to effects on the lungs, occupational exposure to these chemicals increases the risk of some cancers, especially leukemia (benzene), sinus and nasal cancer (formaldehyde) and nervous system cancers (benzene).

Although personal protection equipment can reduce these exposures, many workers don’t use them regularly. Improved ventilation and less-toxic chemicals are needed to protect workers.

Dear Dr. Roach:

I read about a new treatment for Alzheimer’s disease called NeuralCIM from Cuba. Do you think this is real? — J.B.

Answer:

NeuralCIM, aka Neuro-EPO, is derived from erythropoietin — the hormone that stimulates red blood cell precursors to make more blood cells. However, this intranasal form doesn’t stimulate blood cells; it does act like a similar hormone that is made by astrocytes, which are some of the “support cells” of brain tissue.

Among the activities of NeuralEPO in the brain are decreasing amyloid deposits; reducing programmed cell death (apoptosis); reducing inflammatory molecules; improving brain blood flow; and preventing the loss of synapses, which are the connections between brain cells.

A 2023 trial included 170 patients who were followed for a year. A third of the patients received a placebo, a third received low-dose NeuroEPO, and the remaining third received a higher dose of NeuroEPO. There was a significant improvement in the drug-treated groups (especially in the high-dose group), while the placebo-treated group showed a decrease in improvement. The effect size was much larger than previous studies that used the most common Alzheimer’s drugs, such as donepezil or memantine, although they weren’t compared directly.

Still, this was a relatively small trial, and the authors recommend larger trials to determine the efficacy and safety of this potential new drug, which isn’t approved by the Food and Drug Administration. I’ve seen many promising treatments look great in small trials and fail in larger ones, so I’m cautiously optimistic until additional trial results are available.

Dear Dr. Roach:

Thirty-six years ago, I was in a car crash with major injuries, including a broken sternum and back with injuries to my heart and lungs. Two years ago, I had a pulmonary embolism that revealed undifferentiated liposarcoma cancer, which I then had surgery to remove. Testing was done and determined that the blood clot wasn’t genetic, and there was no tendency to clot.

Two months ago, I had another pulmonary embolism, which resulted in me coding two times in the emergency room. Why did I get this second clot? Is it due to the car crash that happened many years ago? And what is my life expectancy now after these clots and the coding? I don’t want this to happen again. — J.S.

Answer:

Cancers have long been known to increase the risk of abnormal blood clots. French physician Armand Trousseau noted the association between blood clots and cancer of the stomach and pancreas in 1865. (He subsequently diagnosed himself based on what is now known as Trousseau’s sign.) Any blood clot can then break off and go to the lungs, which is called a pulmonary embolism. Carcinomas (cancer of the gland tissue), especially pancreatic carcinoma, are the most likely to cause blood clotting.

Sarcomas (cancers of connective tissue) are less likely to cause clotting, but they still can cause it, especially when the tumor is large enough to compress the blood vessels. The important point here is that blood clots damage the vessels and always make recurrent blood clots more likely. In my opinion, it’s the cancer from two years ago (and the blood clot it caused) that put you at risk for the second embolism. I don’t think the car crash is a major issue.

For a person with recurrences of pulmonary emboli, especially the life-threatening type you had, most experts recommend lifelong anticoagulation. Although these medicines do increase the risk of bleeding, they reduce the risk of pulmonary emboli, and a balance of the risks and benefits is usually in favor of lifelong treatment. Your regular doctor or hematologist should discuss the options with you.

Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in his column whenever possible. Readers may email questions to ToYourGoodHealth @med.cornell.edu. Copyright 2026 North America Syndicate Inc. All rights reserved.