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This is a healthcare, not a healthcure, website.  It's about all the things you can do to keep yourself and your community healthy.  We will try to combine common sense with current authoritative data.

This is how you stay healthy, not how you get healthy.  Some of it is about what you do (get thin, stop smoking, consume vegetables, run for 20 minutes).  But a lot is what we must do to our politicians (beef up disease prevention centers, cut water and air pollution, use airwaves for a host of public health information to enable our citizenry, target dollars at bigest disease conditions, expand charters of lower-rank and lower-paid health professionals).

232. -new- New Way to Attack Brain Cancer
“Designed to disrupt the division of cancer cells in the brain, the device –the “Novo TTF” (TTF stands for ‘tumor- treating fields’) delivers alternating electrical fields to the cancer cells by means of insulated electrodes on the surface of the scalp.  The four electrodes, each covered with a bandage, are worn under a white cap.”  “A New Way to Treat Brain Cancer?,” WSJ, June 8, 2010, p. D2. The device comes from Israel based NovoCure and is specifically designed for glioblastoma, a common and often devastating form of brain cancer. See American Society of Clinical Oncology abstract. (06-16-10)

231. Culture Vs. Alcoholism

“When confronted with the rowdy youth in the bar, we are happy to raise his drinking age, to tax his beer, to punish him if he drives under the influence, and to push hm into treatment if his habit becomes an addiction. But we are reluctant to provide him with a positive and constructive example of how to drink.  The consequences of that failure are considerable, because, in the end, culture is a more powerful tool in dealing with drinking than medicine, economics, or the law.”  Malcolm Gladwell, “Drinking Games,” The New Yorker, February 15 and 22, 2010, p.76.  Certain groups, such as Italian first generation emigrants, who have cultural norms that govern their drinking, exhibit much less alcoholism than ethnic groups that do not share similar norms.  Custom and culture achieve moderation, while laws and strictures eventually produce rebellion and lawlessness. (02-24-10)

Update:  Why AA Works?

In “Secret of AA: After 75 Years, We Don’t Know How It Works,” Wired takes a look at Alcoholics Anonymous, restating some useful truisms, but not advancing our understanding of what alcoholism is all about.  It clearly alludes to the group’s religious overtones, but does not grasp how that plays a part in its success.  As Drew Pinsky remarks, “In my 20 years of treating addicts, I’ve never seen anything else that comes close to the 12 steps.”  He is one of many experts who know that AA is really the only treatment that works, ministering to 1,000,000 alcoholics at any one time, but yet it only works for a small fraction of the alcohol-addicted population.  As the writer notes, it is hard to tell why AA works:  the writer gives most credence to theories that suggest that it is the power of the group and the intensity of close, positive relationships that make it transformational.  

We think, however, that scientific investigators have learned a bit more than the writer discovered.  In Glad well’s article, mentioned above, we learn that ethnic groups that drink a lot, yet follow a very prescribed regime, tend to avoid alcoholism.  It’s possible that strong cultures with detailed mores that have a tight grip on its members can avoid alcoholism or can even reclaim those who have been caught in its web.  The nature of our social and cultural environment, as much or more than our genetics, seems to determine our relationship to the bottle. (06-30-10)

230. The Genes of Success
“Of special interest to the team was a new interpretation of one of the most important and influential ideas in recent psychiatric and personality research: that certain variants of key behavioral genes (most of which affect either brain development or the processing of the brain’s chemical messengers) make people more vulnerable to certain mood, psychiatric, or personality disorders. Bolstered over the past 15 years by numerous studies, this hypothesis, often called the “stress diathesis” or “genetic vulnerability” model, has come to saturate psychiatry and behavioral science. During that time, researchers have identified a dozen-odd gene variants that can increase a person’s susceptibility to depression, anxiety, attention-deficit hyperactivity disorder, heightened risk-taking, and antisocial, sociopathic, or violent behaviors, and other problems—if, and only if, the person carrying the variant suffers a traumatic or stressful childhood or faces particularly trying experiences later in life.”

“Recently, however, an alternate hypothesis has emerged from this one and is turning it inside out. This new model suggests that it’s a mistake to understand these “risk” genes only as liabilities. Yes, this new thinking goes, these bad genes can create dysfunction in unfavorable contexts—but they can also enhance function in favorable contexts. The genetic sensitivities to negative experience that the vulnerability hypothesis has identified, it follows, are just the downside of a bigger phenomenon: a heightened genetic sensitivity to all experience.”

“Though this hypothesis is new to modern biological psychiatry, it can be found in folk wisdom, as the University of Arizona developmental psychologist Bruce Ellis and the University of British Columbia developmental pediatrician W. Thomas Boyce pointed out last year in the journal Current Directions in Psychological Science. The Swedes, Ellis and Boyce noted in an essay titled “Biological Sensitivity to Context,” have long spoken of “dandelion” children. These dandelion children—equivalent to our “normal” or “healthy” children, with “resilient” genes—do pretty well almost anywhere, whether raised in the equivalent of a sidewalk crack or a well-tended garden. Ellis and Boyce offer that there are also “orchid” children, who will wilt if ignored or maltreated but bloom spectacularly with greenhouse care”  In other words,  those equipped with certain types of genes will shrivel in the wrong circumstance, but will flourish in the right hothouse.  See Atlantic, December 2009. See “Biological Sensitivty to Context” abstract. (12-9-09)

229. Cellphones and Brain Cancer
In “Fact or Fiction?:  Cellphones Can Cause Brain Cancer,”  Scientific American offers a balanced view of this controversial matter,  a reasoned fairness that has been missing from many other testty questions, such as global warming.  The jury is still out.  On the one hand, it makes clear that most of the heavy hitters would say there’s nothing in it and that it would be more or less impossible for cellphone exposure to produce cancer.  On the other, it notes worrying preliminary studies in Sweden where its younger population has a much longer history of high cellphone use,   and enough cancer to matter is showing up in youngsters. 

Cell phones use non-ionizing radiation, which differs from the ionizing radiation of x-rays and radioactive material in that it does not have enough energy to knock around—or ionize—electrons or particles in atoms. Cell phone radiation falls into the same band of nonionizing radio frequency as microwaves used to heat or cook food. But Jorn Olsen, chair of epidemiology at the University of California, Los Angeles, School of Public Health says that unlike microwaves, cell phones do not release enough radiation or energy to damage DNA or genetic material, which can lead to cancer.”
“Recent research suggests, however, that although short-term exposure is harmless, long-term cell phone use may be a different story. Three studies since 1999 indicate that people who have used cell phones for more than a decade may have as much as three times greater risk of developing brain tumors on the side of the head against which they most often hold their phone—an argument for, at the least, shifting ears regularly or, even better, using an earpiece or the speakerphone feature while chatting.”  Incidentally, our science establishment, as opposed to the Russians, showed similar shortsightedness in relation to microwaves.  The paid attention to the waves that had short-term effects, but not to the spectrum that took a long time to do its worst—the time bomb part of the microwave dilemma.

The article does not do a very good job of suggesting what a cautious person might do, especially what parents might do for their cell-addicted children. One needs some sort of wired earphone that plugs in to the cellphone (not wireless earphones) to keep the waves at bay.  Also one would be well served not to carry the phone at the beltline, unless one has a very insulated pouch.  Good wired earphones that plug into cells and such pouches are hard to come by, however. (11-25-09)

Update:  Cell phone Warnings

Government officials, dogmatic scientists, and industry apologists keep sweeping cell phone detritus under the rug, but it just won’t stay buried.  Legislators in Maine and in a few other places are trying to have warnings put on cell phones, indicating that they may be hazardous to one’s health.  Sort of a cigarette warning.  Some fairly serious people have come out with an intriguing rogue report that sounds more alarms about cell phone radiation.  On the one hand, the radiation emitted does not seem sufficient to produce cancer directly—a fact many scientists harp on.  On the other, we are beginning to understand that we don’t really understand the complexities of how cancer is produced, and it is plausible that surrounding tissues in the brain are altered gradually in ways not well understood and that they eventually serve as a catalyst for dormant cancer cells.  We do know, for instance, that short-term and long-term human afflictions are produced by different parts of the microwave spectrum, although we have tended only to study short-term effects in the United States.

The nickel in cell phones sold in the United States poses a lesser health worry.  The Wall Street Journalreports, “Nickel is even used in some cellphones and has been known to cause irritations on users' ears and faces—a phenomenon dubbed "mobile-phone dermatitis." In a study published last year in the Canadian Medical Association Journal, researchers at Brown University tested 22 mobile-phone models and found nickel in 10 of them, mostly on menu buttons and company logos.  To cut down on allergic reactions, the European Union severely restricted the use of nickel in jewelry in 2001 and cellphones last year.” (01-06-10)

Update: Brain Waves and Other Currents

“A new study by Yale neurobiologists David McCormick and Flavio Fröhlich” shows that electrical currents in the brain work to coordinate brain functions and “to synchronize neural circuit activity.”  Yale Alumni Magazine, September-October 2010, p. 31. “This finding may explain why therapies that use electrical fields can be effective treatments for depression, schizophrenia, tremor,” and other patterns.  “But the study also suggests that everyday electrical fields could also influence brain activity.  McCormick worries about the possible untoward effects of such devices as cell phones and power lines, though he has not yet studied their effects.”  (09-15-10)

Update: Mistake in YAM

Readers should be aware that the Yale Alumni Magazine writer appears to have misread the McCormick study cited above. That is, the researchers were referring to endogenous influences, not external currents, in their study.  So they were, in fact, not making any claims about power lines and the like. That is still an entirely different question. (09-29-10)


228. Contagious:  The Network Effect

Any imaginative CEO of any kind of business or institution should read “Is Happiness Catching,” New York Times Magazine, September 13, 2009, pp.28-35, 42, & 57.  It’s a simple notion really.  An awful lot of what we do and even feel comes about because our friend does it, who does it because another friend does it.  The Times calls it “a look inside the emerging science of social contagion.”  Some people talk disparagingly of the “herd mentality.”  But, in fact, most of us are sheep or cows, waiting to be herded.  Investors in the big cities march into the same bad choices in lockstep, simply because they are next to each other.  But it’s possible to turn this domino theory to good effect—to get enough people aligned behind civility that we overcome the vitriol, polarization, and swamp behavior peddled by cable TV, fringe groups, and pathological people not kept in check.  This particular article is based on the work of Nicholas Christakis and James Fowler who tapped into the database of the ongoing Framingham Study to achieve some understanding of network effects in small communities.  They have published their conclusions in a raft of publications, including The New England Journal of Medicine, The British Medical Journal, The Journal of Health Economics, starting in 2007.  What this means is that we cannot conquer certain entrenched health problems—smoking, obesity, etc.—if society at large is dedicated to unhealthy behaviors.  All our healthcare reforms are for nought unless we can first migrate to a healthy society.  Likewise, companies that want to introduce a pathfinding product or service need to infect society with new notions, or they will have disappointing results. (10-28-09)

227. Cautions on Genome Research

“David Goldstein of Duke University, a leading young population geneticist known partly for his research into the genetic roots of Jewish ancestry, says the effort to nail down the genetics of most common diseases is not working.” He says, “After doing comprehensive studies for common diseases, we can explain only a few percent of the genetic component of most of these traits….For schizophrenia and bipolar disorder we get almost nothing; for Type 2 diabetes, 20 variants, but they explain only 2 to 3 percent of familial clustering, and so on.””  (“A Dissenting Voice as the Genome Is Sifted to Fight Disease,” New York Times, September 16, 2008, p.D3.  “What has happened is that a multitude of rare variants lie at the root of most common diseases….” (10-28-09)

226. Eczema and Asthma
Asthma is a disease of the richer, developer countries, almost absent in poor nations.  “The direct cause is a chemical distress signal produced in skin that is damaged by another hazard of modern life: eczema.”  Eczema, though not harmful in itself, is on the rise in the West: “17% of children in America have it, and similarly high figures are found in Australia, Britain and New Zealand.”  In American 70% of eczema sufferers will get asthma.  “The culprit is thymic stromal lymphopotetin (TSLP), a signalling molecule secreted damaged skin cells….”  Steroids, rarely used, would be the best way to treat the eczema.  One suspect might be detergents.  See “Breathe Easy,” Economist, 23 May 2009, p.85.  See also “Skin-Derived TSLP Triggers Progression from Epidermal-Barrier Defects to Asthma.” (09-09-09)

225. Cutting the Fat

In “Taking 30 Pounds Off America,”  we found that losing weight is an infinitely complex process where individual willpower only goes so far, which hardly gets us down the field.  Fatness is, in the end, just one symptom of an unhealthy, addictive society where many things have to be re-aligned if the nation is going to lose weight.  So we will be compiling all sorts of insights about obesity and weight loss here as they arise:

“Thinking makes you hungry, and thinking really hard makes you really hungry.”  The Week, September 26, 2008, p. 21.  Students at Laval University were given tasks that required varying amounts of thought:  those with heavy-think tasks ate a lot; those with easy tasks just nibbled. See “Glycemic Instability and Spontaneous Energy Intake: Association With Knowledge-Based Work”

“The cost of treating obesity doubled over a decade,” and “may have soared as high as $147 billion in 2008, the Centers for Disease Control and Prevention said….”  “Cost of Treating Obesity Soars,” Wall Street Journal, July 28, 2009, p. D3.  “Obese people spent 42% more than people of normal weight on medical costs in 2006….”  “In his speech Monday, Dr. Frieden said measures that had worked to control tobacco, such as taxes and reduced exposure, could help reduce obesity, too.”  Formerly New York City’s Health Commissioner, Thomas Frieden now heads the CDC. 

“The reasons behind the leveling off in childhood obesity in the United States, Australia, France, Switzerland, Sweden and New Zealand remain shrouded in mystery.”  Wall Street Journal, July 22, 2009, p. A11.  This is in stark contrast to the 90s when children’s waistlines seemed to be swelling uncontrollably. 

“Kelly D. Brownell, a psychologist at Yale, says that when trying to lose weight, motivation matters most.”  “For a Frugal Dieter, Weight Loss on a Sliding Scale,”  New York Times, July 4, 2009, p. B6. “ “Keeping weight off permanently is a lifelong process,” says James O. Hill, a psychologist and a founder of the National Weigh Control Registry (www.ncwr.ws), a database of 6,000 people who have lost weight and kept it off.”  (08-12-09)

224. Bio for Bees: Bee Plaque

  For several years now an illness has been afoot that has devastated bee colonies. “Researchers are scrambling to find the cause of the ailment, called Colony Collapse Disorder.” (Associated Press, February 12, 2007). “Reports of unusual colony deaths have come from at least 22 states. Some affected commercial beekeepers — who often keep thousands of colonies — have reported losing more than 50 percent of their bees. A colony can have roughly 20,000 bees in the winter, and up to 60,000 in the summer.” “Scientists at Penn State, the University of Montana and the U.S. Department of Agriculture are among the quickly growing group of researchers and industry officials trying to solve the mystery” “Cox-Foster said an analysis of dissected bees turned up an alarmingly high number of foreign fungi, bacteria and other organisms and weakened immune systems.”


It should be noted, however, that waves of disease have periodically stricken bee populations since colonial times.  It is possible this is just another one of those serious but predictable outbreaks. Beekeepers lost 37% of their hives in 2008, and 31% in 2007.  “Enter Beeologics, a Miami Biotech startup that aims to create vaccines for all viruses that could lead to CCD.”  Fortune Small Business, March 2009, p.27.  “Ilan Sela, 71, an Israeli expert on sequencing the genome of bee viruses” is involved. “Jeff Pettis, head of the USDA’s Bee Research Laboratory, is cautiously enthusiastic about Remebee’s potential.”  This is their first vaccine to be sold at $2 a does in summer 2009. (06-03-09)

223. Cancer:  Get It Way Early with Statistics

“The US spends billions of dollars to save these late-stage patients, trying to devise better drugs and chemotherapies that might kill a cancer at its strongest. This cure-driven approach has dominated the research since Richard Nixon declared war on the disease in 1971. But it has yielded meager results: The overall cancer mortality rate in the US has fallen by a scant 8 percent since 1975. (Heart disease deaths, by comparison, have dropped by nearly 60 percent in that period.) We are so consumed by the quest to save the 566,000 that we overlook the far more staggering statistic at the other side of the survival curve: More than a third of all Americans—some 120 million people—will be diagnosed with cancer sometime in their lives. Their illness may be invisible now, but it's out there. And that presents a great, and largely unexamined, opportunity: Find and treat their cancers early and that 566,000 figure will shrink.”  Wired, “Why Early Detection Is the Best Way to Beat Cancer,” December 22, 2008.  “This new approach treats diagnosis as an algorithm, a sequence of calculations that can detect or predict cancer years before it betrays symptoms. It starts with a statistical screening to identify people, like Rosenthal, who have a genetically greater risk for disease. A regular blood test follows, one primed to look for telltale proteins, or biomarkers, correlated to specific cancers. A positive result prompts an imaging test to eliminate false positives or isolate a tumor. The process is methodical, mathematical, and much more likely to find cancer than current diagnostic procedures.”  “In 2004, he (Listwin)  created the Canary Foundation, a research group with the single goal of bringing a battery of screening tests to patients and their doctors by 2015, starting with ovarian cancer and moving on to pancreatic, lung, and prostate. Listwin likes to explain the Canary approach with PowerPoint, and every presentation starts with a slide of the survival curve for cancer. Pointing to the 90 percent, he makes this simple observation: When we see cancer early, we have a chance to fight it.”

Quite a body of research is growing up in which mathematics is being put to work on cancer detection.  See “Can Math Cure Cancer?” Forbes, October 27, 2008, pp.74-76.  Kristin Rae Swanson of the Unversity of Washington has “created a software program that uses data from magnetic resonance imaging scans to simulate how fast a patient’s brain tumor is likely to spread.” “Swanson’s” equation “bears a certain resemblance to the Fourier heat equation.”   (03-04-09)

222.Doctor Restaurants
“A new type of eatery called a ‘doctor’s restaurant’ … is becoming popular in Japan.  Such restaurants provide menus that have been certified by physicians from a medical standpoint” (Trends In Japan, 8 August 2008).  “One such establishment is Tokyo Food Theater 5+1, located in Tokyo’s Akihabara district.  Medical specialists were involved in planning this restaurant’s menu.  The ‘anti-aging and beautiful skin’ course, for example, was developed under the supervision of Professor Shirasawa Takuji, who teaches a course on anti-aging medicine at Juntendo University, Graduate School of Medicine.”  “Osaka, meanwhile, is home to a restaurant called Chishoku Shunsai ETSU, whose cuisine is designed specifically to be safe and healthy for people with diabetes.”  “Mikuni Minceur is located inside the Yotsuya Medical Cube in Tokyo’s Yotsuya district, and it serves mainly French food under the concept of providing customers with ‘beautiful, delicious, and healthy cuisine.’ This restaurant's cuisine minceur features a variety of tastes contained within low-fat foods.” (11/5/08)

221. Getting Water
A goodly portion of the world’s population does not have access to germ-free water.  Huge problems ensue for people in underdeveloped nations.  Mikkel Vestergaard of Denmark, who spent a goodly amount of time in Nigeria, has, as a result, devised the LifeStraw, “a personal, portable water purifier that eliminates virtually all waterborne bacteria and most viruses responsible for causing diarrheal diseases.”  Today he heads a family firm in Lausanne, Switzerland, Vestergaard Frandsen, which makes the LifeStraw.  It uses textile and iodine filters, and carbon to sift out the taste of iodine.  Founded as a maker of work clothing, it shifted into 1992 to relief-aid products.  It also manufactures PermaNet, an insecticide treated mosquito net.  (9/24/08)

220. Health Phone
Everybody makes a big deal out of all the schemes to deliver us better health over the Internet, ranging from patient information records to sundry ways of providing information about diseases and sundry health conditions.  The trouble is that most of them are created by and designed for health nerds who are earning their living in the health business.  They’re not for patients.  In fact, the telephone is the best device for dealing with live patients and helping them out, since the sickest are elderly and not inclined to use computers.

Along comes Voxiva in Washington, D.C.  Paul Meyer, its chairman, has a “long history of pulling off projects in challenging locations: Albania, Guinea, India” (Forbes, June 30, 2008, pp. 58-60).  “Meyer created a communications system that works on any telephone network and can be accessed on any mobile handset, PC or landline phone using voice messages, e-mail or SMS text.”  “Last year the company grew 58% and was cash flow positive in the fourth quarter.  Today Voxiva has 120 employees, clients in 15 countries, and 60 projects underway.”  (9/10/08)

219. Hospital Towns
“What happens when a clinic takes over a metropolis?” (Economist, February 23, 2008, p.44).  “A select few cities have entered the era of the mega-hospital. The most dramatic are Rochester, a medium-sized city where Mayo has long been a star business, and Cleveland, Ohio, a rustbelt city that has seen its hospitals boom and one, the Cleveland Clinic, become a new economic force.  Each hospital is a behemoth:  Mayo’s revenues in 2006 totalled $6.3 billion, Cleveland’s $4.4 billion.” “The Cleveland Clinic is America’s best heart hospital; Mayo tops the rankings for neurology, digestive disorders and endocrinology.” Their systems are huge, and their main campuses are larger than the Pentagon.  “Cleveland’s 37,350 employees make it Ohio’s second-largest private employer in 2006, after Wal-Mart.  Mayo is Minnesota’s biggest private employer.”  Both have become big destinations for health tourists. Both have branched out in various ways to other locales, expanding their revenues.  However, this article really does not evaluate what happens to the community when it is host to a health colossus.  We do not even know if it has a positive, neutral, or negative effect on the city’s health. (7/30/08)

218. Cortisol and Chronic Fatigue Syndrome
“The researchers, writing online in The Journal of Clinical Endocrinology and Metabolism, said the low levels of the hormone, cortisol, might play a role in the severe fatigue found in many patients with the syndrome” (New York Times, January 29, 2008, p. D6).  “We were surprised that the effect was limited to women,” Dr. Reeves said in an email message, “and this may help to explain the higher prevalence of C.F.S. in women.”  We suspect the cortisol variation is a symptom of the disease condition, rather than a causative factor.  Nonetheless, it is still heartening to get any faint hint as to what goes on with this elusive disease.  See “Attenuated Morning Salivary Cortisol Concentrations in a Population-based Study of Persons with Chronic Fatigue Syndrome and Well Controls” (JCEM, December 26, 2007).  (4/16/08)

Update: Roots of Chronic Fatigue Syndrome
Scientists have new hunches as to the origins of chronic fatigue syndrome or myalgic encephalomyelitis (ME).  It may have its roots in genetics.  ME Research UK and Irish ME Trust had a recent meeting where new findings emerged.  Jonathan Kerr of St. George’s University in London said he and his colleagues have identified 35 genes that are expressed differently in CFS sufferers.  Julia Newton of Newcastle University found that the automatic nervous system may be askew in many acute sufferers: those taking exercise suffer from acid build-up in the muscles.  It’s thought that drugs that help maintain blood flow could make up for the erratic nervous systems.  There is some thought that CFS may come at the tail end of a period of infectious disease in those with a predisposition to such fatigue.  (10/8/08)

Update: CFS Virus? A study published in Science suggests a linkage between a retrovirus and chronic fatigue syndrome. See “Detection of an Infectious Retrovirus, XMRV, in Blood Cells of Patients with Chronic Fatigue Syndrome,” Science, October 8, 2009.   “Thousands of patients have already contacted scientists, asking to be tested, said Dr. Judy Mikovits, the first author of the study and the research director at the Whittemore Peterson Institute in Reno, a research center created by the parents of a woman who has the syndrome.”  New York Times, October 13, 2009, ppD1-D2.  “The new suspect is a xenotropic murine leukemia virus-related virus, or XMRV….” It has been detected in ¼ of men with prostate cancer as well, and comes from the virus family that causes AIDS and leukemia.
“An estimated 17 million people world-wide suffer from chronic fatigue syndrome, and the Centers for Disease Control and Prevention puts the U.S. figure at between one million and four million.”  Wall Street Journal, Ocotber 9, 2009, p.A3. Retroviruses stay residually in the body permanently, once a person is infected.  “Dr. Mikovitz said they also found XMRV in people with autism, atypical multiple sclerosis, and fibromyalgia.”
Hillary Johnson, who has written a book about CFS called Osler’s Web and maintains a website about it, usefully commented on this new discovery in the New York Times.  She notes that the medical establishment, inside and outside of government, has ignored this disease for decades.  Once again, onerous diseases that affect millions (but not tens of millions) are moving towards resolution because of dynamic advocates from outside the medical sector such as Ms. Johnson and the Whittemores. (11-11-09)

Update: The Jury’s Still out on CFS

Two groups of researchers are at odds as to whether a virus called XMRV if linked to chronic fatigue syndrome.  Scientists at the Food and Drug Adminstration concluded that the virus is found in the blood of CFS sufferers.  “Separately, scientists at the CDC, led by microbiologist William Switzer, concluded in a paper in another journal, Retrovirology, concluded” that they could not find it in the blood of CFS patients.  Such a conflict is not unusual, as scientists struggle with discoveries in a new frontier.  We note, however, that we have talked with some sufferers who have been tested and found positive for certain viruses and retroviruses:  they report some success with the use of alternative treatments in the herbal domain where anecdotal evidence is somewhat positive.  We suspect, for the first time, that scientists are pointed in the right direction, even though much more must be understood about the viral mechanism.  See Wall Street Journal, June 30, 2010, p. A7. (08-04-10)

Update: Jamie and Her Daughter

On August 24, 2010, the WSJ published a front-page headline story “New Hope in Fatigue Fight.”  If the truth be told, it was simply rehashing old news.  Researchers are circling viruses and retroviruses, believing that some viral combination accounts for at least the bulk of CFS.  But there’s one little gem.  The article makes reference to Mrs. Jamie Deckoff-Jones, a Santa Fe doctor and CFS suffer whose daughter is also afflicted.  “Both tested positive for XMRV and are taking a combination of three anti-retrovirals.”

“Dr. Deckoff-Jones said a year ago she could only get up for short periods during the day. After five months on the drugs, she flew last week to Reno for an XMRV conference. Her daughter was able to go to a party and is enrolling in community college. "This is all very new, and there is no way to know if improvement will continue,'' Dr. Deckoff-Jones wrote in an email, "but we appear to be on an uphill course.''”  Dr. Deckoff-Jones maintains a blog which all should read, since doctors who have a disease and are working on its cure are very good resouces.  It is called X RX.

Those interested in the initial research in Reno which pointed to the role of retroviruses should view a series of videos that record the October 2009 testimony of Dan Peterson before the CFSAC in Washington D.C.  (09-15-10)

217. Garlic's Magic Gas
Garlic, it seems, stimulates the body’s generation of hydrogen sulfide—and that turns out to be a good thing.  See “Unlocking the Benefits of Garlic, “ New York Times, October 15, 2007.  “In the latest study, performed at the University of Alabama at Birmingham, researchers extracted juice from supermarket garlic and added small amounts to human red blood cells.  The cells immediately began emitting hydrogen sulfide, the scientists found.  The power to boost hydrogen sulfide production may help explain why a garlic-rich diet appears to protect against various cancers, including breast, prostate and colon cancer, say the study authors.  Higher hydrogen sulfide might also protect the heart, according to other experts.”  As it turns out, one needs to eat 5 to 8 cloves a day to get a bang.  Further, one should let the garlic sit 15 minutes after crushing, before using it in cooking.  (4/2/08)

216. Blood Pressure: Containing the Gorge
Another instance where we don’t know which is the chicken and which is the egg.  People with lower blood pressure are happier, and visa versa, but who knows what causes what.  “Researchers at the University of Warwick have found a direct connection between a nation’s overall happiness and its citizens’ blood pressure problems.  Sweden, Denmark and the UK come top of this blood pressure based happiness league while Germany, Portugal and Finland come bottom.”  “Happy countries have fewer blood-pressure problems.  Mental health in each country, they show, is also inversely correlated with its rate of hypertension.  The study ranks countries in this order: Sweden, Denmark, UK, Netherlands, Ireland, France, Luxembourg, Spain, Greece, Italy, Belgium, Austria, Finland, Germany, Portugal” (Press Release, University of Warwick, 18 Feb. 2007).  (1/30/08)

215. Dutch Health Insurance
The Dutch have come up with a scheme where everybody gets health insurance, but private health insurance carriers provide the coverage.  See “In Holland, Some See New Model for U.S. Health-Care System,” Wall Street Journal, September 6, 2007, pp. A1 and A14.  “Since a new system took effect here last year, cost growth is projected to fall this year to abot 3% after inflation from 4.5% in 2006.  Waiting lists are shrinking, and private health insurers are coming up with innovative ways to care for the sick.”   Everybody gets health insurance; insurers must accept everybody who applied; the government provides aid to those who cannot afford premiums through a tax on the rich. Menzi’s has opened primary care centers of its own to lower costs; UVIT gives discount vouchers to those using low cholesterol dairy products and offers other incentives for consumers leading healthy lives.  This is along the lines of Alain Enthoven’s managed competition.  The government also provides ‘risk equalization’ payments to companies for taking on the elderly and chronic patients with certain conditions. The changeover has apparently gone rather smoothly with premiums lower than predicted.  Generic drug prices have also come down due to negotiations by the government.  The insurers, however, have had some profit difficulties, and it remains to be seen whether they can get hospitals to cut costs to help shrink their burden.

As in many things, healthcare innovation appears to be taking place outside the main developed nations (U.S., Germany, Japan, etc.).  We have previously pointed to Finland as the country that has shown the most dramatic gains from activist public health measures.  (11/28/07)

214. Super Testing 
Akonni Biosystems in Maryland is working on a gadget that will test for everything on the cheap.  It will look for every kind of infection, and it won’t cost an arm and a leg as does the present battery of tests for diseases.  “Daitch calls his tool TruDiagnosis.  It combines advances in microfluidics (miniaturized pumps and channels), microarrays (micron-sized sensors affixed to a chip), and engineering into what could be the ultimate medical gadget: a handheld device that, using a small sample of blood or spit, reveals in mere minutes every pathogen inside the body.  It would work in hospitals, in labs, in the field, perhaps even in homes.  TruDiagnosis is Akonni’s twist on so-called molecular diagnostics, the promising discipline that detects the presence of a bacteria or virus when only a few molecules of DNA, protein, or other biomarkers are present.”  “Akonni … is going low-cost, high-volume.  The TruDiagnosis system has two parts: the credit card sized array, which can be tailored to detect combinations of diseases or strains of a particular disease, and the device that processes and reads the array.”

“Right now, Akonni’s reader is about the size of a Nintendo Wii console.  Daitch is producing a prototype for a handheld device that looks very much like an iPod.  But making it work is a challenge more worthy of the iPhone—cramming three functions onto one tidy package” (Wired, July 24, 2007).  (11/14/07)

213. Mainstream Botanical Drugs?
The FDA, for the first time, is looking at botanical drugs in a serious way.  “Some 250 botanical drugs have … been cleared to proceed to clinical trials.  See “Dueling Therapies: Is a shotgun better than a silver bullet?” Wall Street Journal, March 2, 2007, p. B1.  On the Global Province we include an essay from one noted researcher—“A Third Arm for the First World”—suggesting to the FDA that botanical alternatives be included in all drug trials, since the vast majority of manufactured drugs show such an array of side effects.  At least the FDA has opened the door to useful botanical trials.

By and large, the results with botanicals have been spotty.  “One company that is aiming to beat the odds is Phynova, a small British drug-research concern that has the green light from the FDA to test a hepatitis botanical drug.  The drug is a combination of four different plants: the roots of the astragalus and the Chinese salvia plants, the fruit of the schisandra plant, and milk thistle.  The hope is that they will all work synergistically to combat the symptoms of chronic hepatitis.”  We had a doctor in the Far East look over the ingredients; he replies: “Good combo, probably with the latter two ingredients best.” (10/31/07)

212. Counter “Sicko” 
“Average lifespan has increased 30 years over the past century—mostly due to commercially developed vaccines,” says Paul Offit, chief of infectious diseases at Children’s Hospital in Philadelphia (“Sick Propaganda,” Wall Street Journal, July 13, 2007, p. A13).  Nine vaccines—“which save about eight million lives a year”—were made by Maurice Hilleman of Merck.  Offit is right about vaccines, of course, which he uses to put down Michael Moore’s Sicko, which castigates the pharmaceuticals.  Unfortunately it’s a false argument.  The pharmaceuticals and the healthcare system are peddling treatments galore that are useless or worse, with responsible estimates suggesting that 1/3 of healthcare procedures simply should not be done. As Moore makes clear, this is wasteful and horribly expensive.  Vaccines and preventive care, which the hopeless Moore does not dwell on, must become the order of the day.  (9/19/07)

211. Training Rural Doctors 
“Now, a company called Haoyisheng.com Inc. … has set up outlets in remote villages and small cities like Mile (pronounced Meel-eh), where local doctors attend video classes in essential matters of diagnosis and care.  So far, Haoyisheng.com has outfitted 6,000 classrooms in eight provinces, with the blessing of the Chinese government, which has brought in more than 120,000 doctors to educate” (Wall Street Journal, July 10, 2007, p. B1).  Local doctors see videos that deal with the kind of clinical situations that are expected to crop up regularly.  Distance learning courses such as these are cheap and practical, but the trainees do suffer from lack of one-on-one contact with a medical professional.

“In Mile, the fee for three years of classes is 3,400 yuan (about $448), plus 400 yuan for books.  Haoyisheng receives about 1,200 yuan per student from the government.  The company, which has training programs in urban areas as well as short-term courses on topics such as emergency medicine, says it had a profit of $1 million last year on revenue of $9 million.”  (9/12/07)

210. Blood Pressure Vaccine? Brain Pressure? 
There are reports of a new blood-pressure vaccine “based on a protein found in the sea creature the limpet.  The new vaccine consists of a course of three injections followed by a booster every six months; the vaccine attacks a hormone called angiotensin which is produced by the liver and is the main culprit in raising blood pressure.” (Pharmaceutical News, 15 May 2007).  Developed by a firm called Protherics, there are already many questions about its efficacy.  A Swiss firm, Cytos Biotechnology, is also reported to be developing a similar product.

Interestingly, variant theories are now appearing as to what causes high blood pressure. Some UK scientists trace it to the brain, instead of the heart or blood vessels.  We suspect this will produce entirely new treatments that will affect other parts of the causal chain.  The University of Bristol, which is spawning much innovative research reports:

Professor Julian Paton and his colleagues Hidefumi Waki and Sergey Kasparov, have discovered a new protein, JAM-1 (junctional adhesion molecule-1), which is located in the walls of blood vessels in the brain.

JAM-1 traps white blood cells called leukocytes which, once trapped, can cause inflammation and may obstruct blood flow, resulting in poor oxygen supply to the brain.  This has led to the novel idea that high blood pressure—hypertension—is an inflammatory vascular disease of the brain.

An article about this hypothesis appears in the June 2007 issue of Hypertension.  (8/22/07)

209. Try a Little Tenderness 
The doctors have all sorts of wretched, leech sucking ways to make you think you are getting better.  If it does not hurt, it must not be doing you any good.  One of the mouthwash companies once improved the flavor of its brand, and sales went into the tank.  People figured that if it tasted good, it must not be going you any good.  So the brand managers made sure, once again, that it tasted awful.  Now imagine our substitute for antibiotics—honey.  How, some will ask, could honey be good for what ails you?

Honey was commonly used in medicine before antibiotics became widespread. It is still used in the Antipodes; an Australian company makes a product called Medihoney for medicinal use. This formulation is a certified medicine in Europe, but has not been much used there because doctors developed a taste for prescribing conventional antibiotics.

Research in Australia and New Zealand suggests that honey heals because it attacks bacteria in several different ways at once. Because honey is composed of saturated sugars, it sucks up water, depriving bacteria of the liquid they need to survive and multiply. As bees make honey they secrete glucoseoxidase, an enzyme that releases the bleach hydrogen peroxide when it comes into contact with wound liquids. The low-level but frequent release of this chemical ensures regular anti-bacterial washes of the wound. (Economist, 26 April 1007)

Importantly, honey seems to work against some of the deadly germs that are resistant to antibiotics and that one finds in hospitals.  (8/8/07)

Update: Honey for Coughs  
Every time we turn around we discover new uncanny applications for honey that touches on a variety of complaints.  The Penn State College of Medicine has discovered that it is a good thing to stem children’s uncontrollable coughing, better in fact than many standard cough medicines.  “The study found that a small dose of buckwheat honey given before bedtime provided better relief of nighttime cough and sleep difficulty in children than no treatment or dextromethorphan (DM), a cough suppressant found in many over-the-counter cold medications.”  See “Effect of Honey, Dextromethorphan, and No Treatment on Nocturnal Cough and Sleep Quality for Coughing Children and Their Parents,” Archives of Pediatric and Adolescent Medicine, December 2007.  (4/30/08)

208. Britain Health Productivity Reforms 
The Labor government is trying to get its arms around National Healthcare Costs and Quality.  First off, it is paying its hospitals in a different way.  Before they got block grants based on previous budgets.  Now they get paid by transaction, and the hope is that they will do more for their money.  But, too, there is a counterbalance to make sure they are not doing lots of unnecessary procedures.  That is, the status of General Practitioners has risen, and they will be gatekeepers with a budget who pass on whether patients really need this or that treatment.  See the Economist, March 3, 2007, p.58.  It’s the latter problem that particularly affects America, where it is estimated that perhaps 1/3 of the medical procedures that are rendered are rather unnecessary.  We’re doing a whole mess of medicine that does not help the patient, and often hurts.  (8/1/07)

207. Looking into Eyeglasses 
Eyeglasses—and optometry—add up to one of the greatest scams in the healthcare systems with gullible consumers paying $200 or more for a pair of spectacles.  Simple glasses should cost you $5, or $10 at the worst.  Sam’s, Wal-Mart’s warehouse discount unit, once charged you $20 or so for 12 pairs, back before it got so heavily in the jewelry and eyeglass business—and they had good frames to boot.  Now the average drugstore sells off-the-rack glasses with shoddy frames for $15 a pair.  The New York Times, May 5, 2007, has done a credible job of looking at the problem in “Do-It-Yourself Eyeglass Shopping on the Internet.”  What it comes down to is that you can find some wares on the Internet at better, if not fair, prices, though it is still a fragmented, over-priced mess.  “But a frame that costs less than $25 to make in Italy can retail for at least $150 at an optical shop in the United States.”  Zenni Optical does seem to offer good bargains using China frames.  Glassy Eyes reviews various vendors—and tries to cut through the eyeglass scam.  “Although the frames carry fat profit margins, the real money for the retailer is in the lenses.  There the markup can be three to seven times the wholesale price.  Most single-vision lenses—those that are not bifocals or the ‘progressive lenses,’ which are bifocals without the line—are precast in large quantities and can cost about $1 to make.  The eyeglass dispenser just picks them out of a tray.”

The Times does bring out of the closet one vital piece of information your optometrist may not share with you.  “The one crucial piece of data most consumers are probably missing is the pupillary distance, which is how close the eyes are to each other.  That remains fairly constant in adulthood, but it varies from one person to the next.”  “Any eye doctor or optician can provide the number.  It is against the law for an eye doctor to refuse to give you a copy of your prescription.  In most states, they are under no obligation to provide the “P.D.”  Some doctors, especially those selling the eyeglasses, may refuse because they know that with that number you can shop elsewhere.  Just insist on it.”  Insist on it.  (7/25/07)

206. Stroke Watch
“As of today, the Society for Vascular Surgery … is for the first time recommending these three tests to screen for artery disease in many people 55 years old and over” (Wall Street Journal, April 17, 2007, p. D2).  They are: a carotid ultrasound to find fatty plaque in neck arteries; ankle-brachial test to get at plaque in the legs and throughout the body;  and abdominal ultrasounds to see if the aorta has a bulge or aneurysm.  Some free offerings can be found at www.vascularweb.org.  A high percentage of the nation’s strokes are attributed to carotid blockages.  (7/18/06)

205. Coenzyme Q10 
“Companies that sell Coenzyme Q10 say daily doses improve heart function and increase energy levels.  Scientific evidence on Coenzyme Q10 is mixed, and physicians urge patients not to stop taking conventional drugs” (Wall Street Journal, March 27, 2007, p. D2).  Scientists are clearly mixed about it, though they generally seem to agree that it offers no harmful side effects.  There has been an issue as to quality—with samples sometimes not including intense enough quantities of the supplement.  Then too, one must test to find products with high enough absorption rates.  “For effective therapy in patients with heart failure,” one is apparently striving “for 2.5 to 3.5 micrograms of the coenzyme for every milliliter of blood,” compared with the normal .8 customarily found before treatment.  Advocates think it adds energy to parts of the body where high energy is required.  A wider range of applications is suggested in some articles.  While the WSJ urges readers not to discontinue other heart medications when using it, some researchers suspect that statins, beta blockers, and blood pressure drugs may cut its efficacy.  (7/11/07)

204. Happiness Is Very Low Key
“Mental health and blood pressure are a better guide to happiness in Europe than economic performance.”  A study of 16 countries found that people who regarded themselves as happy had lower blood pressure.  “People in Sweden, the Netherlands, Denmark, the UK and Ireland had the fewest blood pressure problems, while those in Portugal, Germany, Italy and Finland were among those with the most” (Financial Times, March 3-4, 2007, p. 2).  “It is now well established that people in richer countries tend to be happier,” but high economic growth rates do not necessarily correlate with happiness.  Economists studying happiness have had mixed success uncovering what kinds of things produce people with a high sense of wellbeing.  (5/30/07)

203. Doctors Who Write 
Abigal Zuger, a doctor herself, has written a very thin article about “Doctors Who Wield the Pen to Heal the Profession,” New York Times, May 15, 2007,  p. D6.  First off, we find that doctors who write are mainly healing themselves, sensitive individuals who actually have some guilt and remorse for the fact that they are made of mortal clay and have committed some grievous errors along the way as they have plied their trade.  It is not altogether certain that their writing, inspired as it is, really does much to change the profession, which has structural flaws that are so deep that they will not submit to the limited analysis of medical practitioners.  She particularly mentions two New Yorker writers, Atul Gawande and Jerome Groopman, both best-selling stars of the moment, who are part of the Harvard Medical/Mass General orbit.  Gawande has written convincingly about the venalities of the trade where habit and avarice affect performance.  Groopman has touched on many of the habits and mental shortcuts that lead to poor diagnosis, something that even led to poor treatment for him.  One wishes that Zuger had dealt with the raft of other fine medical writers such as Lewis Thomas of Memorial Sloane Kettering, Richard Selzer of Yale, and the incomparable Oliver Sacks—each of whom is endowed with a special esthetic sense that takes their writing to a higher plane.  Consistently, incidentally, the best writing in the New Yorker is about a health, probably indicating that both its editors and readers are a bunch of hypochondriacs.  Henry Finder, its editorial director, is a card-carrying health writer.  (5/23/07)

202. Anti-mottainai
Mottanai means ‘what a waste,’ and, more than ever, the Japanese are eager to waste not.  “Fruits and vegetables that are rejected for sale because they are irregularly shaped or bruised are often thrown away.  Now, however, these otherwise perfectly good foods are being used in purée form under the brand name Nepurée.”  See Trends in Japan, February 5, 2007.  “Nepurée products are made from fruit or vegetables that have been subjected to intense heat for a short time and then made into puree form using centripetal force.  The application of heat brings out the sweetness that fruits and vegetables naturally contain, and because no cutting instruments are used, the nutritional elements are undamaged at the cellular level.  The manufacturer Vegetech Co. and its partner Kanto Orto Co. released products last year bearing the message ‘the new shape of vegetables.’”  (4/4/07)

201. Tips Before You Go to the Hospital
“If your ailment doesn’t kill you, the hospital will.”  As we said in “Hyper-Germs and the Power of Soap,” hospital infections have gotten much more deadly and claim a considerable number of lives.  The AARP gives some good suggestions on things you personally can do to guard against infection: 

  • Wash your hands frequently. And don’t be shy about reminding doctors, nurses and aides to wash theirs.

  • People who smoke or are overweight are more susceptible to infection, so try to quit and lose before surgery.

  • Wash with 4 percent chlorhexidine antibiotic soap for several days before surgery.

  • Ask your doctor for a nasal swab test for MRSA.

  • Be sure the doctor prescribes an antibiotic for you before surgery.

  • Don’t allow the doctor to shave the surgical site—tiny cuts from the razor can get infected. Use hair clippers.

  • Ask friends and family to stay away if they’re ill, and ask the doctor to limit the number of aides and medical students in your room.

  • Call a nurse promptly if IVs or catheters become loose or damaged; the sites should be kept clean and dry.  (3/21/07)

200. China—Drugs, Hospitals, Tests, Fancy Procedures
The broken healthcare system in China—a great worry for the political leadership—exposes even more dramatically the conflict between the incentives built into the healthcare system and cost effective, health effective healthcare.  This is the same tension we discussed previously in respect to Virgina Mason Hospital in Seattle.  See “In China, Prevention Pits Doctor Against System,” Wall Street Journal, January 16, 2007, pp.A1 and A18.  The Chinese have lost the safety net offered in more doctrinaire times of public services and healthcare: now citizens must pay stiff fees without the aid of healthcare insurance.  Doctors and hospitals are rewarded for procedures and prescriptions, so large chunks of unaffordable, expensive healthcare are inflicted on patients without particular regard to outcome or cost effectiveness.  The WSJ discusses Dr.Hu Weimin of Loudi, who offers sensible preventive care measures and low-cost prescriptions to a burgeoning population of patients.  He has been ostracized and even beaten by doctors and barred from the wards of Loudi General Hospital because he has cut into their revenues. “Academic studies show that 50% of all Chinese health-care spending is for drugs.”  Some 63.8% of medical expenditures in China are paid privately, 87.6% coming out of the pockets of individuals—higher even than the U.S.  “With his Web site, he manages some 7,000 patients and runs a high-blood-pressure support group with 50,000 members…”  (3/14/07)

199. Getting Hospitals off Drugs
One of the impediments to health care reform is that the system incentivizes doctors and hospitals to spend money on the unnecessary—and does not reward them for frugality.  In “A Novel Plan Helps Hospital Wean Itself Off Pricey Tests,” Wall Street Journal,  January 12, 2007, p. A1, we learn how Virginia Mason Medical Center in Seattle has taken some halting steps to get off the tests, procedures, drugs bandwagon.  “A novel solution, crafted with the help of the big employers, ultimately let Virginia Mason share in some of the savings it created—by paying the medical center more for some cheaper treatments.  It offers a lesson in dealing with one of the most confounding elements in America’s health-care crisis: a perverse system of payments that rewards doctors and hospitals not for how well they treat patients, but for how much they treat them.”  “Virginia Mason's move is a gamble.  Only Aetna, which accounts for 10% of the medical center’s business, has adjusted fees to reward its more efficient care.  Seattle’s two biggest health insurers, Regence Blue Shield and Premera Blue Cross, haven’t matched the move so far.  Medicare, despite its own experiments, doesn’t have the flexibility to change its payments for one hospital—and it accounts for a third of Virginia Mason’s business.  Virginia Mason, a not-for-profit that is satisfied with an annual 1% to 3% operating margin, still hasn’t replaced all its lost revenue.”  “The medical center has pursued efficiency by adopting some assembly-line methods of Toyota Motor Corp. and Hitachi Ltd., which hospital officials and doctors observed on a visit to Japan in 2002.  For instance, Virginia Mason rerouted patient traffic in its cancer center, cutting the time patients had to wait for chemotherapy from four hours to 90 minutes.”  (2/28/07)

198. Cholesterol and Diet? Maybe
When one does comparative analyses of heart disease incidence in various nations, one can often find comparable disease rates in nations with quite disparate fat intake rates.  Namely, there are all sorts of anomalies that suggest that the simplistic cholesterol studies by which American doctors set their compass and which drives the vast dispensation and usage of Lipitor and its statin cousins may not hold water.  Also more data on the danger of statins is coming to light which we will share in a future entry.  While looking harder at the science, we would still say cut your fats; in fact, cut most everything except vegetables and fruits.  But don’t look askance at others who don’t share your bias.  For an very amusing look at some of the ‘fat’ anomalies, take a peek at the very amusing “The Case of the Missing Data,” which suggests that our understanding of heart disease is still pretty primitive, in spite of all the half baked theories that are foisted upon us.  (2/14/07)

197. Trust for America's Health
The Trust for America’s Health is trying to put preventive health at the top of our healthcare agenda and hopes to restore the public health system in the United States.  Its annual study just said that we are rather unprepared for any major emergency, be it a pandemic or a terrorist threat.  Buried in its website are rankings of all the states according to a variety of health yardsticks.  In troubled states, one will detect considerable weakness on child mortality and on other child issues.  (1/31/07)

196. Hibernation for Humans?
Cell biologist Mark Roth has done research on “induced metabolic hibernation, in which he has shown that it is possible to reversibly reduce the core temperature of mice to 10 degrees Celsius without loss of life or neurological problems,” which, in theory, could lead to breakthroughs in the treatment of trauma and cancer.  See “Buying Time Through Hibernation on Demand,” Fred Hutchinson Cancer Research Center Release, April 21, 2005.  For an abstract, see “H2S induces a suspended animation-like state in mice.”  It is thought that such treatment could, for instance, save accident victims by putting them on ice, as it were, until they can be treated at a full-scale emergency facility.  (1/24/07)

Update: Ice Therapy for Cardiac Arrest

“The treatment is called therapeutic hypothermia and at its core is the simplest of technologies: ice.  Once a patient’s heartbeat is restored, emergency-room doctors …are quickly applying ice to moderately lower a patient’s body temperature by about six degrees. Then the patient is put in a drug-induced coma in intensive care for 24 hours before gradually being warmed back up to normal temperature.”  “How Ice Can Save Your Life,”  Wall Street Journal, October 6, 2009, pp.D1-D2.  It was formerly felt that if the heart stopped beating for more than 10 minutes, the brain would die: now revival has occurred with hearts out of action for 20 minutes or so.  Historically only 10% of cardiac arrest patients return to health.  (11-11-09)

195. Preventive Health Websites
“Web Site Tallies Your Risk of Disease and Tells you What  You Can Do About It,” Wall Street Journal, October 31, 2006, p. D1. The site www.yourdiseaserisk.com, created by the Harvard Center for Cancer Prevention, provides custom, rather than generic information, to help patients understand their health situation and the odds that they will get a severe disease.  “More important, it also spits out a tailored action plan on ways to lower risk for health problems.”  “Other Web sites offer calculators to help users assess their risk for various health problems.”  The American Heart Association offers one at www.americanheart.org, but it does not take into account enough variables.  The National Cancer Institute’s www.cancer.gov/bcrisktool suffers from the same sort of problem: it does not take enough individual variables into account.  The Harvard site lets users calculate their risk for “12 different cancers … heart disease, stroke, diabetes and osteoporosis.”  (12/27/06)

194. Hyper-Germs and the Power of Soap
We cannot over-emphasize the importance of the rise of superbugs immune to traditional antibiotics—a topic on everybody’s lips that is much remarked upon in the media.  The New York Times, for instance, opined that “Concern Mounts as Bacteria Resistant to Antibiotics Disperse Widely” (August 22, 2006).  We have previously commented on “New Classes of Antibiotics,” talking about some scientists who are trying to develop radically different antibiotics that can do battle with a range of pill-resistant diseases that have sprouted up.  Oddly enough, Big Pharma, puzzled by the difficulty of uncovering effective new antibiotics, has dropped out of the fight.  The infection problems are accentuated by widespread and unnecessary use of antibiotics which leads to the development of resistant bacterial strains but which often kills off beneficial bacteria, especially in the human gut.  Promiscuous use of antibiotics in very young children is credited with creating higher asthma rates, especially when used in the first year of an infant’s life.  Hospital infections, especially in America, run rampant: it is such a problem that, by default, rural populations often live longer simply because they don’t have access to hospitals where they would otherwise stand a good chance of getting a life-threatening infection. 

Forbes (June 19, 2006, pp.60-74) does a fine job with the subject in an article entitled “Germ Warfare,” discussing “six strains of killer bacteria, built for destruction and rapid reproduction and bred in hospitals nationwide, [that] are among those that worry doctors most.”  They are: Methicillin-resistant staphylococcus (MRSA), which causes 100,000 hospital infections a year; Clostridium difficile, which causes 400,000 cases of diarrhea annually; Klebsiella pneumoniae, of which cases are up almost 50% in five years and, when untreated, kills two-thirds of patients; Acinetobacter baumannii, which is soil borne and heavily afflicts soldiers in Iraq and Afghanistan; Vancomycin-resistant Enterococcus Faecium (VRE), which is hard on those with weak immune systems and accounts for 10% of hospital infections; and Pseudomonas aeruginosa, which accounts for 18% of hospital-acquired pneumonia. 

“100,000 Americans die of hospital -bred infections” each year; “2 million patients get hospital infections….  This crisis costs $30 billion a year.” 

Sundry smaller companies are doing the pathfinding work now on new antibiotics and other drugs.  Stuart Levy, a Tufts infectious disease expert, co-founded Paratek Pharmaceuticals, which is testing a souped-up tetracycline. He is author of The Antibiotic Paradox, which deals with the over-use of antibiotics and the subsequent outbreak of antibiotic-thwarting killer bugs.  Roy Vagelos, retired chairman of Merck, now heads Theravance, which crushes fragments of old drugs to make powerful new versions.  He is aiming for a new and improved vancomycin. 

Old-fashioned treatments, such as silver, have shown considerable ability to reduce infections, as we mentioned in “Silver Standard.”  As well strict observance of protocols in intensive care units, with discipline reinforced at the highest level of a hospital, can result in a “95% Success Rate” in reducing infections. 

The more things change, the more things stay the same: cleanliness is still next to godliness.  Simple hand-washing and other old-fashioned hygienic measures among hospital personnel, and particularly doctors, can cut hospital infections dramatically.  “Strict infection-control measures and prudent antibiotic use have let hospitals in the Netherlands avoid the resistant staph strains that plague most U.S. hospitals.  Hospitals test patients to identify carriers of staph, which ‘colonizes’ the nose when it is not causing infection.  In the Netherlands at-risk patients go into isolation, and doctors who are carriers are sent home and can’t return until they are cleared, says Margaret Vos, who heads infection control at Erasmus University Medical Center.”  Testing has reduced infections 90% at the University of Pittsburgh Medical Center, and other tests are at various stages.  Prophylactic measures that prevent infection are more effective, and more cost efficient, than drugs administered after the fact. 

But we cannot under estimate the difficulty of getting professional health personnel to take hygiene seriously.  Doctors are the worst of the bunch.  Not to be missed in this respect is “Selling Soap,” New York Times Magazine, September 24, 2006, pp. 22-23.  “In its 2000 report ‘To Err Is Human,’ the Institute of Medicine estimated that anywhere from 44,000 to 98,000 Americans die each year because of hospital errors—more deaths than from either motor-vehicle crashes or breast cancer—and that one of the leading errors was the spread of bacterial infections.” 

Cedars-Sinai in Los Angeles “needed to devise some kind of incentive scheme that would increase compliance without alienating its doctors.  In the beginning, the administrators gently cajoled the doctors with e-mail, faxes and posters.  But none of that seemed to work.  (The hospital had enlisted a crew of nurses to surreptitiously report on the staff’s hand-washing.)  ‘Then we started a campaign that really took the word to the physicians where they live, which is on the wards,’ Silka recalls.  ‘And, most importantly, in the physicians’ parking lot, which in L.A. is a big deal.’” 

“When the nurse spies reported back the latest data, it was clear that the hospital’s efforts were working—but not nearly enough.  Compliance had risen to about 80 percent from 65 percent, but the Joint Commission required 90 percent compliance.”  “They pressed their palms into the plates, and Murthy sent them to the lab to be cultured and photographed.  The resulting images, Silka says, ‘were disgusting and striking, with gobs of colonies of bacteria.’  The administration then decided to harness the power of such disgusting images.  One photograph was made into a screen saver that haunted every computer in Cedars-Sinai.  Whatever reasons the doctors may have had for not complying in the past, they vanished in the face of such vivid evidence.”  (11/15/06)

Update: Pre-Screening and Discipline
Handwashing can do a lot.  But more complex strategies seem to be indicated in countries where super-infections are well entrenched.  Apparently scorched-earth policies in the Netherlands and Scandanavia have kept in-hospital infections rates low.  In England, University of Bath researcher Mark Enright notes, the rates are higher.  Something different is required where microorganisms have gotten well entrenched inside hospitals.

All that said, prescreening of patients can make a big difference.  “One strategy, long popular in some Northern European countries and gaining traction here, is to screen every patient admitted to the hospital, and isolate those who are infected.  This morning’s New York Times describes a Pittsburgh VA Hospital that’s adopted mandatory testing of patients and some simple measures to cut the number of MRSA infections from about 60 per year to 17 last year.”  (11/7/07)

Update: Positive Deviance

Working with hospitals around the country on MRSA, “the Sternins take an unorthodox approach…known as positive deviance, or P.D., which builds on …their health work in poor countries in Southeast Asia.”   Some are not suffering from the MRSA problem.  “Understanding precisely what the 30 percent are doing differently, and then encouraging these positive deviants to educate the other 70 percent, can effect significant changes in group behavior.”  The MRSA rate at a Pittsburgh hospital dropped 50 percent after adopting cleaning checklists and other notions suggested by everybody ranging from doctors to janitors.  An orderly at another hospital came up with a good method of removing infected hospital gowns:  his name was Jason Palmer and this tactic is called the Palmer Method.  See more at www.positivedeviance.org  New York Times Magazine, December 14, 2008, p.68.  Jerry Sternin is working on this initiative at Tufts University.  The idea here is to what a what a minority—sometimes a very small minority-is doing right, and using this is a model for the whole group.  Ibsen, we think, called this the compact minority. (1/6/09)

193. Competitive Disadvantage
In “Risk Pool,” New Yorker, August 8, 2006, Malcolm Gladwell discovers that the dividing line between the Asian Tigers (i.e, the high growth economies and companies of Asia) and the American and European sluggards is dependency costs.  In other words, Westerners, and particularly Americans, are laying out huge expenditures on a company by company basis for pensioners both for health and retirement.  Too high a dependency burden puts an unsupportable overhead cost burden on all companies, particularly those with overcapacity—such as the car companies:

The difference is that in most countries the government, or large groups of companies, provides pensions and health insurance.  The United States, by contrast, has over the past fifty years followed the lead of Charlie Wilson and the bosses of Toledo and made individual companies responsible for the care of their retirees.  It is this fact, as much as any other, that explains the current crisis.  In 1950, Charlie Wilson was wrong, and Walter Reuther was right.

Charlie Wilson was Engine Charlie Wilson, of course, the famed leader of GM who railed against pooled pension schemes, preferring to things on a company by company basis.  Walter Reuther was the auto union leader who understood that both workers, companies, and the countries would enjoy more stable growth if the burden was spread over a range of companies.

“Demographers estimate that declines in dependency ratios are responsible for about a third of the East Asian economic miracle of the postwar era; this is a part of the world that, in the course of twenty-five years, saw its dependency ratio decline thirty-five per cent.  Dependency ratios may also help answer the much-debated question of whether India or China has a brighter economic future.  Right now, China is in the midst of what Joseph Chamie, the former director of the United Nations’ population division, calls the ‘sweet spot.’  In the nineteen-sixties, China brought down its birth rate dramatically; those children are now grown up and in the workforce, and there is no similarly sized class of dependents behind them.  India, on the other hand, reduced its birth rate much more slowly and has yet to hit the sweet spot.  Its best years are ahead.”  (11/1/06)

192. Chilies Fight Cancer
“Capsaicin, the chemical that makes chile peppers hot, may have the power to destroy cancer cells” (The Week, April 7, 2006, p. 20). Cedar-Sinai in California has discovered that it shrinks prostate tumors in mice 80%, and, in lab tests, the spice killed 75 percent of human cancer cells.  See “Capsaicin, a component of red peppers, inhibits the growth of androgen-independent, p. 53 mutant prostate cancer cells.” See PubMed.  (10/11/06)

191. Microbial Fat
“It’s clear that diet and genes contribute to how fat you are.  But a new wave of scientific research suggests that for some people, there might be a third factor—microorganisms” (“Fat Factors,” New York Times Magazine, August 13, 2006, pp. 28-33, 52-57).  “One year ago, the idea that microbes might cause obesity gained a foothold when the Pennington Biomedical Research Center in Louisiana created the nation’s first department of viruses and obesithy … headed by Nikhil Dhurandhar.”  Jeffrey Gordon at Washington University in St. Louis believes obesity is related to intestinal microorganisms.  (10/4/06)

190. Cleanliness and Antibiotics Equal Allergies
A Duke study tentatively confirms that the too-hygenic environment children encounter in advanced developed countries plays a significant part in the development of allergies. The study suggests that an overly hygienic environment could simultaneously increase the tendency to have allergic reactions and the tendency to acquire autoimmune disease, despite the fact that these two reactions represent two different types of immune responses.  See “Increased IL-4 production and attenuated proliferative and pro-inflammatory responses of splenocytes from wild-caught rats (Rattus norvegicus),” Scandanavian Journal of Immunology and other articles.  Meanwhile, British Columbia researchers believe that asthma rates among children continue to rise because of excessive use of antibiotics.  Infants who intake antibiotics during their first year of life are twice as likely as other children to develop asthma.  Earlier studies within the United States have led to much the same conclusion.  (9/27/06)

189. The Genes Will Out
For the first time, really, gene therapy seems to be getting at tumors.  See the Wall Street Journal, September 1, 2006, pp. All & A13.  Such therapy had only worked in a very small cohort—2 out of 17 patients with advanced melanoma.  Genes had previously worked for other kinds of disease conditions, but this is the first time they have bitten into cancer.  The work was done by Dr. Steven Rosenberg of the National Cancer Institute.  He took T-Cells and a receptor from one patient, and a couple of patients then showed “dramatic and durable regression in their tumors.”  They’re still clear a year and one half later, and none of the patients are showing side effects from the treatment.  Rosenberg and others wondered why the treatment did not work in more patients, speculating that a weak receptor or other technical difficulties could have limited the results.  See the National Cancer Institute.  (9/20/06)

188. Heart Tricks While You’re Waiting
A string of recent technological developments in Japan are holding out hope for patients awaiting heart transplants, particularly children.  The goal of the researchers involved in these developments is to improve ventricular assist devices (VADs) by making them smaller and more functional, so that they can be implanted into young children and others with serious heart problems.  VADs help the heart to pump blood around the body. For patients awaiting transplants, they play a critical role, helping them to survive until transplant surgery can be performed. 

VADs come in two basic designs, with the pump outside the patient’s body or implanted inside the body.  Current models are large, which restricts their range of use.  Patients must be confined to their beds while using them, and the VADs’ large size prevents them from being used on children and others with small bodies.

But all that may change in the years ahead, thanks to the development of a prototype of the world’s smallest general-use VAD.  The breakthrough is the result of joint research between Tokyo Medical and Dental University and the Tokyo Institute of Technology. 

The device’s pump, a critical component, is circular in shape and small enough to fit into the palm of an adult’s hand.  It measures a mere 6.5 centimeters in diameter and is just 3.25 cm thick.  Due to its small size, researchers believe there is a high likelihood that the new VAD can be used in children as young as 5 years of age for short periods of time.  Clinical testing on the new generation of VAD is planned for around 2009. 

The device is implanted into the body of a patient whose heart is extremely weak from illness.  It is then connected to their heart and sends blood around the body through the turning of the pump’s impellers.  The researchers working on the project hope one day to develop a device that can operate even when the user goes outdoors.

Another recently developed VAD is the result of joint research in Japan by Sun Medical Technology Research Corp. and several universities.  This device is already in use in one patient.  The patient had it implanted in an operation in May 2005 and was released from the hospital the following February, after recovering to the point of being able to stand up and move around.  The developers hope to have this VAD in widespread use in a few years’ time. 

Terumo Corp., Japan, a major medical equipment maker, has completed clinical trials of its own VAD, expected to be sold in Europe by the end of fiscal 2006 (April 2006 to March 2007). 

Such promising developments are good news for transplant patients, many of whom spend prolonged periods waiting for their operations.  This makes the VADs’ role of supporting hearts all the more critical.  (From Trends in Japan.)  (8/30/06)

187. Online Brokers for Lab Tests
A host of firms including MedLabUSA.com, MyMedLab.com, HealthCheckUSA, DirectLabs.com, etc. are acting as brokers over the Internet to directly secure consumers lab tests prescribed by doctors or simply desired by the consumer.  They have tie-ins with local labs in the area of each customer.  The savings can add up to 75% or more.  Quest Diagnostics and Laboratory Corp of America Holdings, the biggies in the lab game, have held back from this market, since they are so tied in to physicians and hospitals.  It is anticipated that this market will grow as consumers control more and more of their outlays in the future.  See the Wall Street Journal, June 20, 2006, p. D4.  (8/2/06)

186. Checking out Prescriptions and Treatments
Consumer Reports long has provided an online database on prescription drugs as part of a partnership with the American Society of Health-System Pharmacists.  Now it has added in for a $9 annual fee herbs and natural medicines from the Natural Medicines Comprehensive database of the Therapeutic Research Center in Stockton, California, as well as its guide to medical treatments.  Conceptually this is a terribly good idea, but we must add that the quality of these databases varies immensely, and we cannot avow that CR has tied itself to the right partners.  (7/5/06)

185. Anthrax Killers
Not all biological weapons are created equal.  They are separated into categories A through C, category A biological agents being the scariest:  they are easy to spread, kill effectively and call for special actions by the pubic health system.  One of these worrisome organisms is anthrax, which has already received its fair share of media attention.  But work in Vince Fischetti’s laboratory at Rockefeller University suggests that a newly discovered protein could be used to fight anthrax infections and even decontaminate areas in which anthrax spores have been released.

“Anthrax is the most efficient biowarfare agent.  Its spores are stable and easy to produce, and once someone inhales them, there is only a 48-hour window when antibiotics can be used,” says Fischetti.  “We’ve found a new protein that could both potentially expand that treatment window and be used as a large-scale decontaminant of anthrax spores.”  Because anthrax spores are resistant to most of the chemicals that emergency workers rely on to sterilize contaminated areas, a solution based on the protein would be a powerful tool for cleaning up after an anthrax attack.

All bacteria, anthrax included, have natural predators called bacteriophage.  Just as viruses infect people, bacteriophage infect bacteria, reproduce, and then kill their host cell by bursting out to find their next target.  The bacteriophage use special proteins, called lysins, to bore holes in the bacteria, causing them to literally explode.  Fischetti and colleagues identified one of these lysins, called PlyG, in 2004, and showed that it could be used to help treat animals and humans infected by anthrax.  Now, they have identified a second lysin, which they have named PlyPH, with special properties that make it not only a good therapeutic agent, but also useful for large-scale decontamination of areas like buildings and military equipment (News Release, Rockefeller University, April 21, 2006). 

Fischetti hopes to combine PlyPH with a non-toxic aqueous substance developed by a group in California that will germinate any anthrax spores it comes in contact with.  As the spores germinate, the PlyPH protein will kill them, usually in a matter of minutes.  The combined solution could be used in buildings, on transportation equipment, on clothing, even on skin, providing a safe, easy way to fight the spread of anthrax in the event of a mass release.  See the Journal of Bacteriology 188(7): 2711-2714 (April 2006).  (6/28/06)

184. Cholesterol Two
The first act in the drugmakers march against cholesterol was a whole line of statin-class drugs, today led by Pfizer’s Lipitor, which that company snapped up through an unfriendly acquisition of Warner-Lambert.  Lipitor is now ladled out at the rate of $11 billion a year, the heart doctors blind to the possible side effects of the statin drugs.  Cholesterol has been viewed as the prime culprit in heart disease since the vaunted Framingham study, and one only meets an occasional physician who looks at heart disease in a more complex way. 

Now we’re talking about “A Second Bullet for Cholesterol,” Business Week, December 5, 2005, pp.77-78.  What’s up is the addition of pills to raise HDL, or good cholesterol.  Sundry products are either now being sold or about to be marketed, such as Niaspan from Kos Pharmaceuticals (with about $400 million in sales), Acomplia from Sanofi-Aventis, a weight loss drug with HDL cholesterol possibilities, Torcetrapib from Pfizer which is mixed with Lipitor to provided a one-two punch cocktail, and Avant’s vaccine.  (6/7/06)

183. Close at Hand
The fine medical writer and physician Jerome Groopman raises more than one interesting question in “Being There,” The New Yorker, April 3, 2006, pp. 34-39: 

In 2003, emergency rooms in the United States treated nearly a hundred and fourteen million people; about one in every hundred received CPR or underwent another kind of resuscitation procedure.  Resuscitations are gruesome … and just fifteen percent, at most, are successful. 

It’s a surprise to many that the revival rate is so low, but it only emphasizes that CPR and other procedures are best begun well before a patient can reach a hospital.  In “Distributed Defibrillators,” we underline the great success Las Vegas has had, simply by putting defibrillators in casinos for quick and easy access. 

Groopman goes on to talk about a movement in medicine to close family relatives into the emergency room to witness such crisis procedures.  While this practice is still not widespread, Groopman expects it to grow, since openness plus patient and family involvement are becoming more and more characteristic of modern medicine.  (5/31/06)

182. Chiles and Cancer
A research team at Cedars-Sinai Medical Center in California, in conjunction with UCLA, has found that capsaicin (one of chile’s firey ingredients) shrinks tumors some 75% in mice with prostate cancer.  Phillip Koefler, the study’s senior author, notes, in effect, that the capsaicin abets “cell death,” a process cancer cells seek to avoid.  Additionally it tends inhibit cancer cell growth.  See Cedars-Sinai Release, March 15, 2006.  See also “Cancer Research.”  And for anti-microbial aspects of spices, see “Spice and Life.”  (5/24/06

181. Smelling out Malaria
The female mosquito, carrier of malaria, “locates her human prey with her exquisite sense of smell.  She can discern human scent from 50 meters away.”  Laurence J. Zwiebel of Vanderbilt, John Carlson of Yale, and three other research groups in Europe and Africa have joined together to see if these blood-sucking killers can be brought low by their noses.  They are developing odor blends to lure mosquitoes into traps.  See “Serial Killer,” Yale Alumni Magazine, March-April 2006, pp.53-58.  In 1986, Carlson “established what was probably the only fruit fly olfaction lab in the country and only the third he knows in the world.”  Twenty years later, there are more than 50.  Attending a London conference on mosquito olfaction in 1995, he learned that “10 percent of the world’s population gets” malaria every year. 

Carlson has used fruit flies as proxies for mosquitoes in his lab experiments.  “Carlson’s daunting task was to identify the genes governing insect olfaction.”  It took him and colleagues until 1999 to identify “the first odor receptor genes in the fruit fly.”  The thought is that repellants and attractants and other devices can be developed that play on the olfactory genes of the mosquitoes.  (5/17/06)

180. Metals Again
More and more, we are discovering the part that metals and sundry minerals play in inhibiting illness, and—in some instances—in provoking it.  We have discussed both arsenic and silver elsewhere.  Brian DeDecker, a cell biologist at Harvard Medical School, just has written abut the role of gold and platinum in Nature Chemical Biology.   “Noble Metals Strip Peptides from Class II MHC Proteins,” disabling the auto-immune system and possibly providing relief for lupus, child diabetes, and rheumatoid arthritis.  See The Economist, March 6, 2006, p. 74.  “Dr. Dedecker and his team have screened some 30,000 chemical compounds … that might adversely affect the proteins in question … without much success.”  Just recently they tried out drugs approved for other purposes: “two … worked, and they had a surprising element in common: platinum.”  In general, not just platinum, but the whole class of noble metals (such as palladium and gold) worked well.  Some gold-based drugs had long worked slowly against arthritis.  Now that it is understood that they curb MHC Protein, it is thought that faster acting drugs can be devised.  (4/19/06)

179. Distributed Defibrillators
“Las Vegas casino security officers have restored the heartbeats of about 1,800 gamblers and employees in the past nine years, according to the Clark County Fire Department.”  See the Wall Street Journal, January 28-29, 2006, pp. Al & A10.  Bryan Hindsoe, a George Washington University emergency-medicine doctor and co-author of paramedic textbooks, alleges that it’s now safer to suffer cardiac arrest in a casino than at a hospital. 

“Casino security officers have become so adept” with defibrillators “that they usually decline offers of aid from physician bystanders.”  Authoritative bodies such as the American Heart Association are now calling for wide distribution of the devices and broader use by lay persons. 

Richard Hardman, a paramedic in the Fire Department, pushed the idea of casino personnel having and operating defibrillators for the stricken.  He got Stan Smith, vice president of risk management at Boyd Gaming (Stardust Casino) to cooperate. 

“The state’s ‘good Samaritan law,’ giving legal protection to bystanders who help in a medical emergency, was extended to explicitly cover users of defibrillators, after lobbying by casinos and Mr. Hardman.” 

“The study’s survival rate astonished specialists in emergency medicine.  ‘This was groundbreaking—it showed what can be accomplished with quick response,’ say Leonard Cobb, professor emeritus of medicine at the University of Washington and the father of Seattle’s paramedic program, widely hailed at the fastest- reacting big-city operation in the country.”  Now corporations, such as Proctor & Gamble, and other institutions are laying in the defibrillators which keep falling in price. 

We would further suggest that lay people should be both allowed and trained to implement a number of doable medical practices which can conceivably lead to broader, faster implementation of sound medical practices at an affordable cost.  We ourselves have seen that experienced nursing personnel in hospitals and elsewhere can often both suggest and render sensible medical procedures that would not occur to physicians of rather narrow experience.  (3/22/06)

178. Bird Flu
Bird Flu is on the fly, and it is becoming a real worry.  A case here and a case there is cropping up—particularly in bird populations, brought on by wild birds on the wing.

Scientists of merit are taking its moves quite seriously, and are worried about a global pandemic.  This rise in concern, from a yellow to a red level if you will, has been brought to our attention by Max Wallace, a healthcare and biotech entrepreneur in the Research Triangle.  We intend to give it a lot of attention—right here. 

The implications are many.  It’s not only a threat to people across the globe, but it already is having business and economic implications.  Some businesses are already beginning their crisis planning, trying to imagine how they can carry on with decimated labor forces.  “Avian-Flu Concerns Overseas” are dampening U.S. chicken exports, according to the Wall Street Journal, March 11-12, 2006, p. A5.  Several importers, especially in Europe, are consuming less chicken, even though proper killing knocks out the virus.  “According to the World Health Organization, the H5N1 virus has killed 97 people since 2003 in the developing world, where people … live in much closer contact with poultry than they do in the West.”  “The wholesale price of so-called dark meat has plunged to about 14 cents a pound in recent weeks, compared with about 41 cents a pound last summer.”  Brazil plans to cut production about 15%, but currently the U.S. production schedules calls for a marginal increase. 

Mainland China, which already has rather serious, unmet healthcare problems, is once again a source for this latest flu, and some feel it is under-reporting its flu cases.  One wonders whether world public health bodies can do enough back channel communication with China to begin to get at some of the sources of its ongoing virus problems—or whether officialdom will try to stonewall this growing problem. 

There are outbreaks everywhere.  See “Sinister Droppings,” The Economist, February 18, 2006, p. 51.  Italy, Greece, Austria, Germany.  Official assurances notwithstanding, chicken consumption has dropped 70%.  Nigeria, a heavy poultry country, has had an outbreak, though there are few signs so far elsewhere in Africa.  Both Azerbaijan and Iraq are worrisome spots.

Controlling bird flu is a complex problem and raises some of the very same issues that we encounter with other kinds of viruses—computer outbreaks, terrorism, etc.  It requires intense collaboration that is not altogether easy, since the world’s public health system is rather broken.  Clearly there is fertile ground here for the application of network theory—a growing body of knowledge not well understood by governments anywhere. 

It is perfectly clear that national jealousies and scientific ambitions are an impediment to dealing with the disease.  Increasingly we are discovering that the only means of rapidly dealing with emerging threats is efficient knowledge markets.  That means widely distributed nodes (researchers) bound together by an open network as well as the will to work together. 

“WHO … runs a database limited to a select group of scientists and containing a massive trove of data—some 2,000 genetic sequences of the virus, around a third of the world’s known sequences.”  See the Wall Street Journal, March 13, 2006, pp. B1-B2.  Ilaria Capua an Italian veterinarian working on avian influenza just received a sample of virus from outbreak in Nigeria.  Instead of supplying her genetic data to the secretive WHO cache, she posted her findings on the Internet in a public database.  WHO, perhaps justifiably, says the closed database is a compromise necessary to get some governments to share the data: scientists agree not to publish results based on the data without prior consultation.  Officials and scientists from the U.S., Switzerland, Croatia, Slovenia, United Kingdom, Iran, and Niger have backed her stand, and often have given her permission to make public sequences they have supplied.  Her data is stored at GenBank, run by the National Center for Biotechnology, part of the National Institutes of Health.  (3/15/06)

Update: Tracking Avian Flu
Airports. “The nation’s major airports aren’t prepared to quarantine a planeload of international passengers, if someone is suspected of carrying bird flu…” (USA Today, March 10, 2006, p.2A).  Honolulu is better prepared than airports on the mainland to spot and handle flu suspects.  The CDC is watching Hawaii to gain insight as to how to control ports and airports in general. 

Quantity Not Quality.  More generally, everyone involved with avian flu is having a hard time tracking it—including the science, public health controls, outbreaks, dispersal of the virus, etc.  There are a host of sites—from WHO to national authorities to self-invented experts: our team has not been able to work its way through all of them.  But we find that many have an axe to grind, from furthering national or scientific jealousies, to expanding on particular political biases.  The UN is trying to do a good job, but as might be expected with this and other institutions, it falls behind the information curve, as events race ahead of its statistics. We have yet to find a group that is doing a comprehensive job of covering avian events, much less a site where the information is presented in an accessible form.

The media is clear that it should be watching, but does not know how to do it.  The New York Times’s Science Times (March 28, 2006, pp. D1-D8) devoted a special section to the topic.  It calls Avian Flu “The Uncertain Threat.”  The title article, which is in itself indecisive and wandering, is entitled “How Serious Is the Risk?”  Dr. David Nabarro at the UN is a worrier; Dr. Jeremy Farrar at the Hospital for Tropical Diseases in Ho Chi Minh City, thinks a human pandemic is unlikely, having watched the slow progress of the disease over some 3 years.

Roeder.  In the absence of an authoritative and decisive news source, we suggest that researchers track what we will call here science entrepreneurs who are trying to manage, understand, and perhaps offer solutions to the disease.  In general the Wall Street Journal has been better at turning up these people than other publications.  See, for instance, “After Fighting a Cattle Disease, Vet Turns to Birds,” Wall Street Journal, March 16, 2006, which focuses on Dr. Peter Roeder, “a 60-year-old British veterinarian … who has spent decades fighting” rinderpest in Africa and Asia, a devastating disease that has long decimated cattle herds.  “Dr. Roeder … has recently been in Indonesia, helping lead the charge against another—the avian influenza know as H5N1, or bird flu.”  Roder knows that “mass vaccinations don’t always work as well as narrowly targeted attacks on the disease.”  “The key to rinderpest’s defeat, he says, lay in being selective.”  Bird-flu experts are beginning to flock to his thinking: at first they had been thinking about vaccinating billions.  Now they are talking about focusing on Guangdong province which is a particularly feisty breeding ground.  At a macro level, Roder also makes a lot of sense: the general problem in health is to learn how to leverage scarce resources for maximum effect, so much of healthcare being stridently wasteful.

Niman.  Dr. Henry L. Niman enjoys a mixed reception in the scientific community, but, nonetheless, he has been a successful communicator about bird flu, leading a voluntary band of bloggists, who collect and spread information about.  See “A Bird Flu Watched Developes a Following Through the Internet,” Wall Street Journal, March 24, 2006, pp. B1 and B4.  In his Pittsburgh home, “the 57-year-old biochemist keeps vigil over a blog and explosion of offshoot internet discussion groups tracking the avian flu virus….”  “They believe mainstream scientists are missing important clues about the virus’s evolution…”  He now has his own business called Recombinomics where he hopes to develop vaccines.  In general mainstream researches are skeptical about his research and flu theories.  He does think that we have moved decidedly closer to a flu pandemic, obviously scaring his tribe of adherents.  Oddly, the WSJ did not appear to publish a link to his website.  It is helpful to peek at WSJ’s Avian Flu Tracker, which is anecdotal but gives you a decent sense of the evolving news. 

George Mason.  Curiously enough, not many comment on the avian flu site that has been hatched by Tyler Cowen and Silviu Dochia at George Mason University.  The Masonites are doing more than basketball. 

“Avian Flu—What we need to know.”  It’s literate and wanders to some topics we do not see elsewhere.  Mr. Cowen has even authored a paper on the subject: “Avian Flu:  What Should be Done,” November 2005, which is hardly definitive, but is creative and worth quite a look (Read the full article, not the summary.)  Mr. Cowen and Mr. Dochia are economists, and we are yet to determine how their avian flu chronicle connects up with their specific economic interests, which we may learn about when we read Mr. Cowen’s other blog “The Marginal Revolution,” which is on economics and the efforts at the margin that can improve economies.  We are pleased, incidentally, to see that George Mason has a flu information page available for students that touches on the rudiments of flu and avian flu.  It is not very good, but at least it exists.  (4/5/06)

Update: Indonesia Worsening
Indonesia is soon to overtake Vietnam as the site of worst human outbreaks of Avian flu. Forty-two people have died over the last year (New York Times, July 21, 2006, p. A10).  Thailand got control of the flu by killing millions of chickens and by Vietnam instituted mandatory vaccinations.  Indonesia has tried limited vaccinations and flock culling with limited success.  (8/9/06)

Update: Bird Flu Vaccine
GlaxoSmithKline reports that it now has produced effective human bird-flu vaccine (Wall Street Journal, July 27, 2006, p.A2).  “In a clinical trial of 400 people, two doses of Glaxo’s vaccine produced a strong immune response against the H5N1 virus in more than 80% of the people who received it.”  These results are much better than those achieved with vaccines of other drug companies. 

Meanwhile, slowly but surely, the bird flu threat continues to intensify (“Thailand Alert for Bird Flue Is Expanded,” New York Times, August 6, 2006, p. 6).  Officials have “put eight more provinces, including the Bangkok area, on a bird flu watch list.”  “The outbreaks in Thailand and neighboring Laos, where bird flu was found on a farm last month, renewed fears that the disease is flaring up again in Asia.”  “Indonesia and Vietnam have each had 42 deaths, the highest number of confirmed human deaths anywhere in the world.”  (8/23/06)

Update: Microchip Flu Test
“Scientists have developed a microchip-based test that could allow more laboratories to quickly diagnose and pinpoint the origin of flu viruses, including the H5N1 avian-flu strain” (Wall Street Journal, August 29, 2006, p. D4).  The FluChip represents a research collaboration between the Centers for Disease Control and the University of Colorado at Boulder.  It will ostensibly be two years before “the test is commercialized” and becomes inexpensive enough for wide laboratory use.  Results were included in the August 2006 issue of the Journal of Clinical Microbiology.  (11/29/06)

177. Arsenic for Brain Cancer
We keep traveling around in circles.  Silver, an old cure for pesky infections, is now being revived to stave off hospital infections.  Once upon a time, arsenic (in the form of salvarsan) was the only cure for syphilis.  Now it’s the hope for some intractable brain cancers.  (2/22/06)

176Silver Standard
We have always preferred silver to gold—now we can rationalize our aesthetic choice.  Silver, it turns out, has curative powers.  Its use against bacteria dates back to the ancients.  “In 1884, a German doctor named C.S.F. Crede demonstrated that putting a few drops of silver nitrate into the eyes of babies born to women with venereal disease virtually eliminated the high rates of blindness amongst such infants” (New York Times, December 20, 2005, p. D5).  Silver is staging a comeback, because of bacterial resistance to many antibiotics and because scientists, manipulating silver ions, can put together more powerful potions.

One critical application is to deal with runaway hospital infections.  There “bacterial infections” affect 2 million a year, killing some 90,000 patients.  It is the worst problem in the hospital environment, more fatal even than mistakes made in treatments and the like.  “The latest advance for silver therapy comes from AcryMed … that has invented a process to deposit silver particles averaging 10 nanometers … on medical   devices”  Its first customer, I-Flow, makes a silver-coasted catheter….”  (1/25/06)

175Just Medical Blogs
Thomas P. Stossel, American Cancer Society Professor at Harvard Business School, has correctly urged us to take medical journals with a grain of salt.  In “Mere Magazines,” Wall Street Journal, December 30, 2005, p. A16, he finds that they are regarded with too much reverence, in that the research they include (a) is not subject to the rigorous detailed examination processes that are required, for instance, in FDA reviews and (b) is normally herd-driven—the articles that get accepted tend to tow the party line, tracking current conventional theories in the medical field.  “Anonymous peer review by jealous competitors has its merits, but it has a tendency to select for fashionable if relatively unoriginal and inoffensive papers.”  For this reason we should not get so exercised when editors at the journals raise a storm about researcher ties to corporate sponsors.  Plenty of bad research creeps in with the good under present editorial guidelines, and there is no clear indication that corporate sponsorship of researchers, in whatever form, has created tainted research we should suspect. 

However, and Stossel does not get into this, articles in these journals are now much, much reported on in the everyday press, even though the research and results only add up to very tentative hypotheses.  Journalists and readers should be cautioned to take all this research with many grains of salt.  We are all too easily seduced by press reports on journal articles: research has a way of flipflopping every few years.  (1/18/06)

17495% Success Rate
One really has to perk up when you come across a 95% success rate.  It’s a dirty secret of hospitaldom that infections run rampant in our best institutions and there’s a good chance you will die from them rather than from a high-risk operation on your next visit to the operating room.  But John Hopkins has found a way around this, as we learn from Peter Kindlmann of Yale and Lee Schulman, president of the Carnegie Foundation for the Advancement of Teaching: 

This makes thought-provoking reading.  It is about quality control in teaching, overtly here in a hospital setting, but by implication also in an engineering program or a company.  It proposes an aggressive attitude, such as in the Johns Hopkins program (described below) which is an aggressive drive to lower to zero the infection rate in intensive care units.  The protocols are stringent and are working.

Early on in this new routine, every nurse was handed two phone numbers—the home phones of the medical school dean and the university president—and told that if a physician didn’t follow protocol and refused to abort the procedure, they were to phone one of these numbers, even at 3 a.m.  That only happened once.  The infection rate at Johns Hopkins for that procedure is now approaching zero.

The piece concludes by asking how much engineering education and student success in courses could be improved by similar methods.

Faculty and teaching institutions face many impediments, just like physicians; the conditions and capabilities of our students are often unknown. But what if at some universities the president was called every time a student failed?  This proposal sounds crazy, I know, but that’s just the point.  We’re too comfortable with our failures; we take them for granted. The good news is that we can do much better. We know a great deal today about how to organize our institutions and classrooms so that students not only stay but achieve at high levels, and research in the cognitive sciences and other fields provides grist for further improvements.  I know we lack the resources.  I know we lack the administrative and policy support.  I know that some students we inherit are already deeply wounded.  Nevertheless, we need to ask much more of ourselves. Education is no place for modest ambitions.

Kindlmann is abstracting the quotes from Lee Schulman’s “Immodest Proposal” which can be found on the Carnegie website.  (12/28/05)

173. Strokes—Before and After
A Simple Test.  If you think a friend has had a stroke, give him or her this simple test:  Ask him to smile; ask him to raise both arms; ask him to speak a simple sentence.  If he can’t do one of the three, call 911 for emergency help.  For more on the success of this procedure, look at the American Heart Association’s “Just a Minute.”  Or, if you prefer, look up the more complicated list of warning signs on the American Stroke Association website, which is a division of AHA.

Life after Stroke.  Again, the American Stroke Association provides some boilerplate hope on how to deal with life once you have had a stroke.  But, in our opinion, you are best served to look at the sites of thinking patients who have been through the whole experience.  You will find that the sites put up by patients and their families vary widely in quality, but will often find the practical hints that there that answer your particular needs.  Example’s are Joe and Jackie’s and Stroke Survivors International. The Stroke Information Directory provides links to a number of survivor groups.  (12/21/05)

172. Blood Readers
“Researchers at Royal Philips Electronics are developing pinprick blood sensors that can detect certain diseases within minutes.  Today’s blood screens can’t spot malaria at an early stage, when the infection is still treatable, because the tests don’t pick up trace particles of the malaria parasite.”  The Philips tests can, and the thought is that it would have high relevance to early detection of heart problems.  It is trying to bring this approach to market as early as 2009.  See Business Week, October 24, 2005.  Even more exciting, we think, is the prospect of biometric sensing systems which would not even prick the skin to read the blood.  The speculation is that they, too, could do very sensitive readings.  (12/7/05)

171. Surgery and Cancer
Years ago, when we could offer cancer patients little hope in many instances, we noticed that surgery seemed to exacerbate an existing cancer and hasten the death of patients upon whom operations had been performed.  Recent studies suggest that “removing a tumor can trigger a process that leads to new growth” (Wall Street Journal, September 13, 2005, pp. D1 and D3).  “In a database of 1,173 breast-cancer patients treated with surgery from 1964-1980 … 520 relapsed.”  “In a 2002 paper published in the journal Lancet, colon-cancer patients who had traditional surgery had a significantly higher rate of relapse than patients who had a minimally invasive laparoscopic procedure.”  See http://breast-cancer-research.com/content/6/4/R372.

170. Teeth without Pain
“Swedish dental implant maker Nobel Biocare … received Food and Drug Administration approval last May for Teeth in an Hour, a quick, minimally invasive procedure for replacing several to all of a patient’s teeth.”  Using Nobel software, dentists do a CT scan of patient’s mouth to perform an analysis.  “Nobel’s Swiss factory uses  these plans to make a stencil-like mouthpiece, predrilled with tiny holes to guide the dentist through surgery.  Once the patient is in the chair, the doctor can affix a set of new chompers in about an hour.”  There are 75 dentists doing the procedure now, but Nobel expects to quickly train more.  The treatment is pricey, $2,000 to $3,000 per implant, or some $60,000 for the whole mouth.  See Forbes, September 5, 2005, p. 103 and www.nobelbiocare.com/global/en/default.htm?langdetect=en.  (10/19/05)

169. Low Cost Medical Care in India
“Mr. Beeney’s story is becoming increasingly common as Europeans and Americans, looking for worldclass treatments at prices a fourth or fifth of what they would be at home, are traveling to India” (New York Times, April 7, 2005, p. C6). Also x-ray scan interpretations and lab testing is being done at low cost in India.  (9/28/05)

168. Growth of Wound-Care Market
Kinetic Concepts is expected to hit $1.2 billion this year, particularly because of double digit sales of its line of vacuum-assisted wound healing devices.  Most of its wound healing technology was acquired from Wake Forest University in 1994.  Its vacuum canisters keep wounds moist as well as sealing them to prevent infection.  “Other recent products include Smith & Nephew’s Acticoat dressings, which incorporate microscopic silver nanoparticles from NuCryst Pharmaceutical to enhance antimicrobial activity.  Another newcomer is a device from Celleration that uses ultrasonic energy to spray a saline mist on wounds.” Johnson and Johnson’s Regranex is a wound care gel incorporates blood cell proteins helpful in early stages of healing.  Oculus Innovative Sciences produces a “superwater,” chlorinated water with charged oxygen ions that it claims will rapidly kill bacteria, spores, etc.  The resultant liquid it calls Microcyn and it has had good results in Mexico, India, and Italy.  See the New York Times, August 5, 2005, p. C3.  (9/21/05)

167Cutting Down on Cut Ups
Business Week (July 18, 2005, pp. 32-35) headlined a very provocative article called “Is Heart Surgery Worth It?”  To a host of medical experts, it is not at all clear that heart surgery isn’t vastly overdone, and many would contend it should be done away with except in instances where the patient is clearly in dire trouble. Norton Hadler, medical professor at UNC-Chapel Hill and author of Last Well Person, thinks bypass surgery in particular should have been relegated to the junk heap a decade ago.  On the other hand, Dr. Timothy Gardner, a cardiac surgeon in Delaware and co-editor of Operative Cardiac Surgery thinks bypasses have worked very well indeed.  Heart surgery is $100 billion industry, and so there are not only health but vast economic questions at stake.  Further, the amount of surgery done may be a proxy for a more general problem—runaway, costly, and ineffective treatment throughout the healthcare establishment.  Both Fisher and Wennberg at Dartmouth have long claimed that a sizable portion of healthcare is not driven by either need or results, but rather by available supply.  (9/7/05)

166Ex-pounded Governor
We remember that Governor Bill, later Pres Bill, had a terrible fondness for all sorts of junk food, constantly battled his waistline, and finally had to give himself over to major heart surgery.  Now we learn that current Governor Mike Huckabee is battling weight in one and all.  He shed 100 pounds by the end of 2004, all recounted in his book Quit Digging Your Grave with a Knife and Fork.  See “The Governor Who Put his State on a Diet,” New York Times, August 10, 2005, p. D2. “His transformation led him to begin the Health Arkansas initiative … the goal of which has been to persuade” his fellow citizens “to join him….”  Under the program, state employees “are given 30 minutes a day for exercise.”  They also get days off as a reward for healthy living.  If all this is not satisfying, one can buy Liza Ashley’s Thirty Years at the Mansion, full of recipes she used to fatten up 7 Arkansas governors.  Read about the fatty years at www.augusthouse.com/catalog/detail.asp?bookID
=530&catID=52.  (8/31/05)

165. Piecework
Boston surgeon Atul Gawande in “Piecework,” New Yorker, April 4, 2005, pp. 44-53, wrote sensitively and provocatively about doctors’ compensation and skyrocketing health costs.  As he points out, physician incomes are a fairly small part of the out-of-control health care pie, but “we’re responsible for most of the spending.”  Nonetheless, some physician incomes are inordinately high.  In surgery, where one effectively gets paid by the operation, this leads, among other things, to an excessive numbers of procedures.  Recent articles have speculated that perhaps 90% of all heart surgery should not be done.  Responsible studies, basically using Medicare data, out of Dartmouth show tremendous treatment variability from one section of the country to another, with no improvement in care or mortality in regions with higher expenditures.  Researchers, as a result, believe that as much as 1/3 of our medical expenditures are unwarranted, driven by an excess supply of physicians and medical facilities.  Perhaps a great deal of this waste results from trade rules that allow a physician to get paid for procedures done or hours expended—instead of for health results.  (8/31/05)

164. Prostate Bible
A prostate specialist and surgeon for 25 years, Dr. Peter Scardino has authored a book—Dr. Peter Scardino’s Prostate Book—that looks at cancer, prostatitis, BPH, and everything else that can go wrong with the prostate.  As The Economist points out, the book is sorely needed.  Prostate cancer, if caught early, is curable, and yet more men die of it than any other cancer except lung.  See The Economist, April 9, 2005, p. 70. Scardino is prostate cancer chair at Memorial Sloan-Kettering.  Interestingly, Scardino got his first degree from Yale—in religious studies.   

Even with Scardino, prostate sufferers will want to read further.  One site with a great deal of digestible information is Phoenix5.org to include links to articles such as the famous Andrew Grove account in Fortune (www.phoenix5.org/articles/menuarticles.html).  We cannot emphasize enough that the Phoenix site is terrific and it should be consulted by anybody with even the vaguest interest in prostate cancer.  And here is yet another reading list: www.seattleprostateinst.com/readinglist.htm.  The sources on prostate problems are wide and deep.  (8/31/05)

163Arsenic Aplenty
In our “Ninety Degrees of Uncertainty,” we touched upon the widespread arsenic contamination of water supplied in both the United States and abroad.  Environmental Health Perspectives, June 2005, looks broadly at the extent of this problem and at new tools for remediation, commenting also on the range of illnesses—cancers as well as cardiovascular and neurological complaints—that can result from this pollution.  See Environmental Health Perspectives.  We have come such a long ways from 1910 when Paul Ehrlich introduced salvarsan (arsenic based) for syphilis in those days before antibiotics, a time when venereal disease sufferers had no effective remedy for their complaints.  Now arsenic itself is the hidden scourge.  (8/3/05)

Update: Dealing with Arsenic
We have previously talked about a world pervasive problem: drinking water that is polluted by toxic quantities of arsenic.  Wells dug some 30 years ago to give villagers in developing countries clean water have turned out to have goodly quantities of arsenic. The wells were a response to bacterially afflicted surface water that led to a host of diseases (www.csmo
nitor.com/2005/0217/p14s01-sten.html).  Finally in 2004 “Tommy Ngai, an MIT graduate student, bought a round plastic bin at a street market in Kathmandu, Nepal.  He and the team filled it with layers of sand, brick chips, gravel, and the magic ingredient—a layer of locally bought iron nails, which chemically bind arsenic to them.  The filter may just be the MIT team's silver bullet, a combination arsenic and biological filter.  Cost: less than $16.”  Of course, this solution may work out in Bangladesh, one of the hardest hit nations, but probably won’t apply to millions of others with somewhat different water conditions in many other nations.  There’s a million-dollar prize out for a more comprehensive solution to the arsenic, and teams at both Harvard and Columbia are working on the problem.  (9/14/05)

162. The Ultimate Sunscreen
“Mexoryl SX, made by the Paris-based skin-care giant L’Oreal, is an illegal sunscreen in this country, one that is thought to be particularly useful in preventing wrinkles.”  It is sold on the side, in any event, by some druggists on the Upper East Side of Manhattan.  “The Canadian website feelbest.com “sells a three-ounce tube for a little over $20,” well under what U.S. druggists peddle it for.  In particular, mexoryl blocks the full range of sun rays effectively, not only the UVB rays to which we attribute sunburn, but the equally harmful UVA rays.  So far the FDA has approved only zinc oxide, titanium oxide, and avobenzone (Parsol) for UVA protection.  UVA rays (320 to 400 nanometers vs. 290 to 320 for UVB)  have a longer wavelength.  Here, we are reminded of the problem we have had in the microwave area, where, traditionally, American devices only offered protection for a narrow part of the spectrum, and waves that were actually more dangerous long term were allowed free range.  See the New York Times, June 9, 2005, p. E3.  (7/27/05)

161. Anti-Scar Drug
Mark Ferguson and Sharon O’Kane of Manchester University have formed a well-funded, venture-backed company called Renovo to develop, test, and market a drug they have developed called Juvista, a synthetic version of TGFbeta3, a protein that acts to both prevent and remedy scarring.  In the 1980s, Ferguson discovered “that wounds an alligator suffered as an embryo would not result in any scarring,” due, as it turned out, to presence of “transforming growth factor beta 3.”  Now in final stage clinicals, the drug should go to market in a few years.  “Scarring of the skin affects an estimated 42 million patients in the U.S.  …  Renovo has three other anti-scarring drugs in advanced clinical trials and an additional 13 in the pipeline.”  The thought, too, is deal with internal scarring as well.  See Business Week (May 30, 2005, p. 89) and www.renovo.com.  (7/13/05)

160. Gene Tests and Coumadin Safety
Scientists at the University of Washington in Seattle and Washington University in St. Louis report that an understanding of the genetic makeup of patients who require coumadin as an anti-clotting agent will eventually provide guidance to physicians trying to establish a proper dosage for this very tricky drug.  Our conversations with conservative physicians indicate that this would not be their drug of choice, because it is difficult to keep its presence or density in the proper range for effective treatment and yet avoid possible side effects.  We should note here that new drugs are beginning to enter late-stage trials that are safer and actually dissolve clots, rather than inhibiting the formation of new ones, which is all that coumadin achieves.  “Dr. Rieder said his team knew that variations in a gene controlling an enzyme known as CYP2C9 accounts for about 10 percent of the differences among patients in their response to warfarin.  But doctors seldom test for the gene, in part because the finding involves relatively few patients.  In this study, the team focused on another gene known as vitamin K epoxide reductase (VKORC1).  The gene makes a protein that breaks down warfarin in the body.”  The latter gene accounts for 25 percent of the variation in warfarin (coumadin) doses in patients under study.  See the New York Times, June 2, 2005 and “Effect of VKORC1 Haplotypes on Transcriptional Regulation and Warfarin Dose,” The New England Journal Of Medicine, June 2, 2005.  (7/6/05)

159. Artery Disease in Seniors
For people over 60 and for those particularly at risk for strokes, artery screening is critical, according to Dr. Eric J. Topol, cardiovascular chief at the Cleveland Clinic.  “Stroke is the leading cause of disability in the U.S. and the third-leading cause of death after heart disease and cancer.”  See the Wall Street Journal, September 24, 2004, p. B3.  “Despite being two decades old, the carotid ultrasound and ankle-brachial test are overlooked exams.”  In a test population of 8,000 the American Vascular Association found that 7% had carotid blockage of greater than 50%.  “One-tenth of the people tested had an abnormal ankle-brachial score.”  At the same time, seniors should be tested for abdominal aortic aneurysms, which are all too common and for which GPs also generally do not test.  See more on this in “Abdominal Faults” below.  By and large, hospital outpatient services overcharge for screenings of this sort, often by a factor of 10 or more, even if the WSJ pushes hospital testing.  Unless one has a clear medical problem, an over-sixty should look around for mobile units that provide a battery of perfectly adequate tests for $125 to $200.  One, for instance, is Life Line Screening at  www.lifelinescreening.com.  (6/15/05)

158My First Year of Cancer (Installment 1)
Silicon Valley executive Stephanie Day has given us her first thoughts about coming down with breast cancer—the discovery and all that rush of things that occurs from the moment you know that it has become your close companion.  She and others such as Brian McBain—who takes us through his years of heart disease in letters of April 7 and April 14, 2004—tell us what we already know: no doctor, no nurse, no healthcare employee really know a disease.  Only the patient knows.  And the lonely patient, amply informed, is his or her own best doctor.  Please go here for a full transcript of “My First Year Living with Cancer.”  (6/8/05)

Update: Day by Day (Installment 2)
Stephanie Day’s wrenching battle with breast cancer goes on.  As she has said, the odds of winning are only about 50%.  Yet she reports to us that her doctor is cautiously encouraged: “I am still on chemo and Herceptin three Fridays out of the month, with shots during the week for blood counts and am feeling slightly more energetic.  My doctor believes that I am getting better....”  Click here to read her update.  (10/26/05)

Update: Never Passive (Installment 3)
This installment concludes Stephanie’s first year of wrestling with cancer, but, we are most happy to report, this will be far from her last chapter.  Cancer and hospitaldom leaves one feeling weak and helpless, but it’s incumbent on anybody with such a critical illness to (a) take charge of one’s fate, even if it puts one at odds with medical professionals and (b) help the thousands of other folks out there who are fighting this existential battle along with you.  In this installment, we learn that yet another divine Ms. Day has spunk enough to call the shots and to give some tips to her fellow sufferers: 

Today, I admitted that my body had finally said “enough.”  Why should I contaminate perfectly good new blood with poison when my oncologist volunteered that skipping the last two chemo treatments most likely would not make a difference one way or the other? 

Today, I appreciated fully how humbling a disease cancer can be and vowed to try to make a difference.  Perhaps by relating my experience so far (I have additional treatments to look forward to) with practical tips along the way I can make it easier for one of those some 250,000 women who will be diagnosed with breast cancer this year.  (7/26/06)

157. Alcoholism Drug?
Vivitrex, a drug from Alkermes (www.alkermes.com) of Cambridge, Massachusetts, has in one study reduced heavy drinking days by 25% in test subjects.  The study was performed by James G. Garbutt of UNC Chapel Hill, employing 624 alcohol-dependents adults.  An advantage is that the drug only has to be injected once monthly.  Traditionally, of course, with alcoholics, the problem is that they eventually fail to take drugs provided them, however administered.  See the Wall Street Journal, April 6, 2005, p. D4.  (5/4/05)

156. Promising Prostate Vaccine
Provenge, from Dendreon in Seattle (www.dendreon.com), has shown promising trial results in advanced prostate cancer sufferers.  Apparently it provides roughly double the impact (months of survival) of Taxotere from Sanofi-Aventis, the only approved treatment for those whose cancer is spreading out of control.  Less toxic than chemo treatments, Provenge attempts to activate the body’s immune system to fight the cancer.  Hence that is why it is called a vaccine.  To follow various prostate cancer therapies, see the Prostate Cancer Foundation at www.prostatecancerfoundation.org/site/pp.asp?c=itIWK2OSG&b
=46403New York Times, February 17, 2005, p. C5.  (4/27/05)

155. Peripheral Artery Disease
Some 11,000, 000 Americans are afflicted by PAD (Peripheral Artery Disease), but we hear little about it and treatments for it are of mixed value.  One can undergo a bypass, leading ultimately to leg amputation.  “Current treatments for peripheral arterial occlusions include angioplasty, stents, surgical bypass and, in 25% of acute cases, clot-dissolving thrombolytic drugs, such as Abbott Labs’ Abbokinase or Genentech’s Activase.”  Nuvelo’s Alfimeprase, an experimental drug, is safer, faster, and acts directly to dissolve the clot, which is at the heart of the disease.  Before approval, Nuvelo must take the drug through satisfactory late stage trials.  Forbes, January 31, 2005, p. 74.  (4/13/05)

154. Wound Water
Oculus Innovative Sciences has “developed a kind of superwater that kills bacteria, viruses, mold and spores at rates comparable to any antiseptic, but without toxic side effects.  The liquid called Microcyn also appears to be a fast wound healing agent for burns, chronic wounds, even diabetic sores.  It is now approved as disinfectant in several countries, but in Canada only, for woundcare.  Zapping water with electricity, the company has created a lot of free ions which invade and damage bacteria cell membranes.  Hoji Alimi, an Iranian, originally licensed the technology from the Japanese who had been looking into a nuclear reactor application, in his search for a cancer cure.  See “Holy Water,” Forbes, February 28, 2005, p. 62.  See also www.oculusis.com.  (4/5/05)

153. Moving Towards Electronic Health Records
Laura Landro, in The Wall Street Journal, February 9, 2005, p. D5, cites 5 innovations which are helping the advent of electronic medical records for patients: Computerized Physician Order Entry, Clinical Decision Support Systems, Electronic Prescribing Systems, Patient Tracking and Verification Systems, and, finally, National Health Information Infrastructure.  She recommends the following to find out more about the electronic initiative: The Markle Foundation/Connecting for Health (connectingforhealth.org), The Foundation for E-health Initiative (ehealthinitiative.org), The Healthcare Information and Management Systems Society (himss.org), The National Committee on Vital and Health Statistics (NCVHS.hhs.gov), and the National Health Information Infrastructure (aspe.hhs.gov/sp/nhii).  (3/30/05)

152. Intransigent Fats
“Partially hydrogenated fat has been the food industry’s favorite cooking medium for decades.  …  But scientists contend that trans fat, a component of the oil, is more dangerous than the fat it replaced.  Studies show trans fat has the same heart-clogging properties as saturated fat, but unlike saturated fat, it reduces the good cholesterol that can clear arteries.  A small but growing body of research has connected it to metabolic problems.”  See The New York Times, February 13, 2005, pp. YT 1 and 23.  “At least 30,000 and as many as 100,000 cardiac deaths a year in the United States could be prevented if people replaced trans fat with healthier … oils … according to a 1999 joint report by researchers at the Harvard School of Public Health and the Brigham and Women’s Hospital in Boston.”  (3/16/05)

151National Cancer Institute
We have put up for you on Global Sites Cancer Resources, which provides you with endless links to sites that may help you with your particular brand of cancer.  The problem, of course, is that this does not really give you guidance or interpretation.  For that you may want to explore the National Cancer Institute at http://cancer.gov as well as the NCI Cancer Bulletin, which can be found at the same site.  It has a lot of bureaucratic stuff but occasionally mentions a new trend in treatments.  This site gets into treatment, clinical trials, etc.—all the things you want to know as you move beyond understanding what you’ve got to looking for what to do about it.  (3/16/05)

150Hospitals that Do Care
If we are to believe Philip Longman, and we do, Veterans Hospitals, reviled just a few short years ago, are “producing the highest quality care in the country.  ...  In 2003 ... the prestigious New England Journal of Medicine published a study that compared veteran health facilities on 11 measures of quality with fee-for-service Medicare.  On all 11 measures, the quality of care in veterans facilities proved to be ‘signicantly better.’”

Other studies show that the VA comes in at the top of the heat on countless measures, including quality of cardiac and diabetes care, two critical areas.  Critical was the work of Kenneth Kizer who in 1994 came to head the system:  he thoroughly shook the place up.

One of the keys has been the use of thoroughgoing information technology to root out errors (the lesser hospitals actually kill a fair number of patients because of mistakes), to improve diagnoses, and to implement coordinated evidence-based care.  See “The Best Care Anywhere,”  The Washington Monthly, January 1, 2005.  As interesting as this article is, we think it does not capture the true breadth of the VA achievement.  For instance, a hefty number of beds and other kinds of facilities were closed down, and, at the same time, the VA built up its outpatient capability.  We suspect the re-allocation of resources was as important to VA success as the retooling of the information systems.  As it happens, our medical system generally provides a vast amount of expensive care we don’t need, and fails to provide enough daily support activity outside the hospital to deal with chronic patients.  (3/16/05)

149. Herbal Malaria Cure
A plant called Qinghao, and named Artemisia Annua by western botanists, is proving effective against malaria, but is in short supply and rising sharply in price.  Its key ingredient, artemisinin, has been extracted from the plant and chemically converted to derivatives with heightened powers against malaria.  When combined with lumefantrine, it has been shown to be very effective as a one-two punch in 90% of those treated.  ACT, as the combination is called, has become more important as traditional drugs become less effective.  WHO is trying to get the developing world to broadly shift to this treatment.   While widespread, the most effective varieties occur in a couple of provinces in China plus Vietnam, leading to a supply shortage: farmers realize they can now ask more for the plant.  Chinese producers are now trying to cultivate the plant rather than simply relying on wild varieties.  Additionally synthetic varieties of artemisinin are being developed in labs which would reduce the cost of treatment substantially.  See The Economist, November 20, 2004, pp. 81-82. (2/23/05)

Update: Malaria Drug Alternatives
Meanwhile, there is a panoply of initiatives and drug development efforts to try to bring malaria to heel.  Dr. Jay Keasling, a California biochemist, is trying to genetically alter bacteria to artificially produce artemisinin, using a $43 million grant from the Bill and Melinda Gates Foundation.  Medicines for Malaria Venture, located in Geneva, is testing 2l drugs, with the most likely winner being Oz (OZ277), a synthetic trioxolane.  “Virtually all malaria experts agree that new malaria regimens must consist of more than one drug.  ..  Though there are many malaria drugs, virtually all are from one of three classes:  artemisinins, quinines, and antifoliates.”  The thought is that cocktails involving more than one class will overcome malaria mutations proving resistant to any one class of drug.  See “Millions of Lives on the Line in Malaria Battle,”
New York Times, January 25, 2005, p. D6.  (4/5/05)

148. Poison Pills
“The number of deaths linked to prescription drugs rose fourfold in Utah from 1991 to 2003 … [a] sharp increase in prescriptions for powerful painkillers.”  The culprit was painkillers:  but, of course, death is the ultimate painkiller. (See The New York Times, January 25, 2005, p. D6.)  “The study was published…in The Morbidity and Mortality Weekly Report, a journal of the Centers for Disease Control and Prevention.” (2/15/05)

147. Ranking Doctors and Hospitals
Atul Gawande’s “The Bell Curve,” New Yorker, December 6, 2004, pp.82-91 examines the effort to evaluate institutional (hospital) and physician effectiveness.  In general he looks into a study of cystic fibrosis care and found the Fairview-University Children’s Hospital program to consistently obtain the best results.  Run by Warren Warwick, who had earlier studied CF care, it succeeds because it focuses so heavily on what’s necessary to keep the lungs open, doggedly doing whatever it can with each patient to pursue that single goal.  As Gawande notes, this kind of study of results, widely applied, would shake the medical profession and hospitals, as it would point out that the performance of so many is average at best.  Boston’s Institute for Health Improvement, run by another pediatrician called Don Berwick, is broadly pursuing an agenda that calls for careful measurement of results and their wide dissemination.  In fact, today, healthcare processes and evaluation do not anchor themselves in outcomes, at great cost to patients and the economy.

146Spice and Life
A somewhat neglected older study, ”Antimicrobial Functions of Spices: Why Some Like It Hot,” by Jennifer Billing and Paul W. Sherman from Cornell in the March 1998 issue of the Quarterly Review of Biology documents the importance of spices, particularly in hot climates, for controlling food diseases, long serving as preservatives and bug killers particularly before refrigeration came along.  Billings did most of the hard slog work, looking at 4,570 recipes from 93 cookbooks for the cuisine of 36 countries.  “Garlic, onion, allspice and oregano … were found to be the most all-around bacteria killers,” according to a Cornell press release about their work.  See The Economist, “Antibiotic Spices,” May 19, 1998.  To get a list of top 30 spices with Microbe Fighting Ability ranked by effective, see the fairly detailed Cornell Release at www.news.cornell.edu/releases/March98/
spice.hrs.html.  Dr. Andrew Weil, incidentally, theorizes that tumeric may offer some help against Alzheimer’s and other diseases, noting that India where it is widely used enjoys lower rates of the disease than other major nations, suggesting that spices with a low ranking as a germicide may be terribly important in other regards.

145. The Sweet Life: La Dolce Far Niente
In several places on the Global Province, we have reported on rising stress in the workplace.  Dan Seligman, a retired Fortune editor who does occasionals for Forbes, is much enjoying his life in the slow lane but is quick to report that stress in the workplace is declining not rising.  Just for balance, we include his thoughts here.  Though Americans work long hours, he notes that Bureau of Labor Statistics show us that hours on the job have been in a “long, steady decline.”  Similarly the BLS, he finds, shows hours lost because of stress to have declined 25% from 1992 to 2001.  For the same period, the National Opinion Research Center reports a big drop in the number of workers claiming to be stressed.  See Forbes, October 18, 2004, pp. 118-20.  Well, maybe the stressless are all clustered in those red states we don’t visit enough of the time. But we’re blue and find it hard to take Mr. Dan too seriously.

144. Not Quite So Fat?
Dr. Jeffrey Friedman of Rockefeller University maintains that the real weight of Americans has remained remarkably constant, but that our statistics are skewed by the truly obese who are growing ever fatter.  “Only with the massively obese, the very top of the distribution, is there a substantial increase in weight, about 25 to 30 pounds.”  Other experts, of course, disagree.  See The New York Times, June 8, 2004, p. D5.  Friedman, who discovered leptin, a hormone released by fat cells, believes weight is genetically driven, and we can only exert control over our weight within a 10 or 15 pound range.  He thinks the hyperbole devoted to obesity and the fat “epidemic” is much overdone.

143. Alchoholics Anonymous
As we have said elsewhere, Alchoholics Anonymous is one of the most worthy non-profits in our society.  It operates on a very low budget (basically it is sustained by passing the hat at its meetings), is by far the most successful remedy available in the world for those who have lost control of their drinking, and, as importantly, depends on the ongoing participation of its members to succeed.  That is, the members who have stopped drinking help initiates who are still getting off the sauce, and help themselves by immersing themselves in the ideology of sobriety.  The group is a model for our society and should be the basis for dealing with most addictive problems and for groping with a wide range of chronic diseases.  To our regret, we have never read its core text called “Alchoholics Anonymous,” and we intend to get a copy.  It is also referred to as the Big Book or the group’s Bible.  In any event, it is authored by Bill Wilson, and sums up the philosophy he and Robert Smith, another founder, originated, which roughly says that only one drunk—on the wagon—can help another.  Wilson’s master draft was slated to be sold at auction by Sotheby’s in mid-June 2004.  See our letter, “Giving” (February 25, 2004).

142. Slicing Medicaid Costs
The UCLA/Johnson & Johnson Healthcare Institute has published a study based on a pilot experiment with 400 families who had children in the Head Start program.  It shows that parents who are trained in health matters will stop taking their children to the Emergency Room or a physician’s clinic for minor complaints such as ear aches or sore throats.  Basically those trained and provided with a health reference book cut their visits in half.  See The Wall Street Journal, April 27, 2004, p. D4.  We have previously read correspondence from hospital employees asking why so many unwarranted Medicaid hospital visits were allowed.  In general, assorted studies of Medicare and Medicaid activity around the country suggest that about 1/3 of the costs of such programs could be averted  with better clinical controls and better patient education.  Systematic healthcare education and cajoling seems to be the only antidote for our healthcare crisis.

141. Better Healthcare Costs Less
“In the fall of 2001, Pitney Bowes Inc.’s corporate medical director, John Mahoney, proposed an unusual experiment:  Slash the amount that employees pay for diabetes and asthma drugs, and see what happens.”  “Since 2001, the median medical cost for a Pitney Bowes employee with diabetes has fallen 12% from about $1,000 a year.  The median cost for a patient with asthma has dropped 15% from $900 annually.  Overall, the company says it will save at least $1 million in 2004, with continued savings in future years.”  See The Wall Street Journal, May 10, 2004, p. R3.  In some measure, this cuts across the notion that the way to save money is to ratchet up employee co-pays.  To some extent, co-pays help contain company healthcare costs, forcing workers to move to low-cost generics.  But “predictive modeling” has shown that getting diabetics and asthmatics (and others with chronic conditions) to take the right drugs regularly will have a better, sustained impact on costs.  Pitney employed Medical Scientists Inc. in Boston (www.medicalscientists.com/index.htm), a predictive modeling firm, to look at this question and render advice.  Later, Medstat, a medical data firm in Stamford, Connecticut, looked at Pitney’s results: the $1 million a year that Pitney pumped into this new program was more than offset by savings elsewhere.

140. Healthcare and the Economy
American wages are more than competitive with those in other developed economies.  But structural costs, which add 22.4 percent to the cost of doing business in the United States, threaten the competitiveness of American business.  “One of the main culprits is health care.”  See “Whose Problem is Health Care,” The New York Times, February 8, 2004, p. BU 6.  After corporate taxes, benefits cost are second largest cost for American manufacturers.  Because of funding out of general government revenues, private sector expenditures for health in Canada are only 2.8 % of gross domestic product as opposed to 7.7% in the U.S.  Major business associations are proposing that the federal government pick up the tab for retiree health care, though so far they have stopped short of advocating the same for their active workforces.  Over the long haul, it would seem, the government will displace private insurance as much to help the economy as to nurture health.  Best of all, of course, would be an attempt on the part of large corporations to attempt the painstaking public health measures that would slice their health and absenteeism costs.

139. Shrinking Americans
Burkhard Bilger in “The Height Gap” (The New Yorker, April 5, 2004, pp. 38-45), speculates on “why Europeans are getting taller and taller—and  Americans aren’t.”  It appears that, on average, their nutrition is better than ours, accounting for the difference.  “The Netherlands, as any European can tell you, has become a land of giants.  In a century’s time, the Dutch have gone from being among the smallest people in Europe to the largest in the world.  The men now average six feet one---seven inches taller than in van Gogh’s day—and  the women five feet eight.”  In the United States, “Tall men, a series of studies has shown, benefit from significant bias.  They get married sooner, get promoted quicker, and earn higher wages.”  “Biologists say that we achieve our stature in three spurts:  the first in infancy, the second between the ages of six and eight, the last in adolescence.  Any decent diet can send us sprouting at these ages, but take away any one of forty-five or fifty essential nutrients and the body stops growing.”  During the last half of the 20th century America was the richest country in the world, but it has faltered by other indicators.  “But by another set of numbers—longevity, income inequality, and crime—it is now trailing Northern Europe and Japan.”  Versus Europeans, Americans suffer most growth-wise in infancy and adolescence, suggesting that post and pre-natal care as well as fast foods have the most to do with the American height gap.

138. Fat Forward
There’s small evidence of progress on the fat front, not only here but abroad.  For the first time in years, Americans dropped a little bit of weight last year.  In Britain, “the average man got thinner in 2002 … for the first time since body-mass-index records began; women’s BMI was static.”  See The Economist, “Fat of the Land,” March 6, 2004, pp. 51-52.  In both America and Britain, there are various schemes being proposed to impose a “fat tax” on the foods that put on the pounds, and an effort to ban junk food advertising for children.  Sales of chocolate in Britain (the Brits are notorious consumers of sweets) have been falling 2% a year, and food companies are edging into healthier foods.  Salads are moving faster on lunch menus, and exercise clubs are increasing their membership at a healthy rate. 

The question, even so, is whether governments should intervene in the marketplace and how.  Kelly Brownell, chairman of Yale’s psychology department and director of its Center for Eating and Weight Disorders, believes that obesity is a public health prevention problem and that government should be active in combating the “toxic food environment.”  In his book Food Fight, he makes clear that individual dieting alone won’t work when one is surrounded by signals that drive you to consume the wrong things.  Whatever the role of government, it seems clear that overweight individuals are still fighting an uphill battle in trying to reduce in a stressful atmosphere that goads them to consume and does not afford them enough leisure to exercise properly.  Nonetheless, a general change in consciousness about health and obesity in many societies already is leading to a loss of weight at the margins.  For more on Dr. Brownell’s views on government and obesity, see Yale Alumni Magazine, “The Belly of the Beast,” March/April 2004, at www.yalealumnimagazine.com/.  Also see his vita at www.yale.edu/psychology/FacInfo/Brownell.html.

Update:  Japanese Take in their Belts
David Nakamura’s  “How Japan Defines ‘Fat,’ ”  Atlantic, November 10, 2009 tells us how Japan stays relatively thin through social pressure and Big Brother government.  “In Japan, being fat remains noteworthy, something that makes you stand out in a shameful way in a conformist society. Even now, despite government statistics and anecdotal evidence that Japanese people are getting heavier, I can go days without seeing a single fat person in Tokyo.”  “Last year, lawmakers established a national limit on waistlines for people 40 and older: 33.5 inches for men and 35.4 inches for women. The program, which aims to cut down on metabolic syndrome, a leading indicator for heart disease and diabetes, has been controversial and critics say it misses the mark scientifically.”  “Not surprisingly, there are unintended consequences. Eating disorders are prevalent, especially among young women. When Ralph Lauren was criticized by the U.S. media after digitally altering an image of already-slender supermodel Filippa Hamilton to make her appear even skinnier, I was not surprised that a company executive said the advertisement had only appeared in Japan.” (12-09-09)

137. 117 Auto Deaths Each Day
New York Times journalist Nicolas Kristof ranks for us America’s real killers.  Automobile accidents kill nearly 43,000 people a year, flu and pneumonia 36,000, guns 26,000, food illness 5,000, and terrorism usually under 1,000.  Sweden, through innovative measures (seat belts, use of traffic circles, flexible guard rails, high use of helmets on motorcyclists) has achieved one of the lowest fatality rates in the world.  Kristof clearly thinks the auto risk deserves much more attention.  See The New York Times, March 13, 2004, p. A23.  As interesting, we think, is the implication that we need to better focus on our biggest risks in any event.  In the same vein, decisions on funding of disease research are not driven by the incidence of any one disease in the population, but by interest groups plumping for their favorite diseases.  When we pay attention to risks, we will be pouring vastly more funds into the prevention of obesity which taxes our health as much as smoking.

136. McFilm
At the Sundance Film Festival in Park City, Utah, one of the hits this year was Super Size Me.  “It’s a film by Morgan Spurlock about his decision to eat nothing but McDonald’s food for one month to see what effect it would have on his body. 

“Both he and his doctors were amazed to find that after just 20 days, the 33-year-old Mr. Spurlock, who started in supreme physical condition, was almost at liver failure.  They encouraged him to abandon the diet, but he continued through the month, gaining a total of 25 pounds and finding himself depressed and listless.”  “The doctors who monitored his progress are now writing a medical paper about the effects….”  See the New York Times, January 24, 2004, p. A27.

135. Alternative Provider
WholeHealth MD.com is an outgrowth of American WholeHealth Networks, which provides alternative health services to sundry custom health-insurance plans.  See www.wholehealthmd.com.  We frankly don’t know a lot about it, so caveat emptor.  That said, it’s a reasonable place to find out more about acupuncture, massage therapy, special nutrition, herbal and chiropractic medicine, etc.  Conventional medical centers have been slow to provide clinical research on alternative techniques, and sometimes, as we learn from hearsay, only alternative options  provide relief for some conditions.  Some allergies, for instance, simply do not respond to any drugs now on the market.

134En Garde
We have long advised chief executives that they are really their own investment bankers and that they must press all the levers to get a deal done, whether it is a financing, a merger, or the sale of an unwanted unit.  The boys in the Street are simply overpaid technicians whose main expertise is extracting excess fees from unwitting companies. 

So too, you must understand you are your own best diagnostician.  This was recently re-confirmed in an article by Kevin Helliker in the Wall Street Journal (December 23, 2003, p. D1) about Karen Murray and her son.  Her young son Michael was born with a rare condition, although it is five times more common than cystic fibrosis.  Afflicted with a clutch of symptoms, Michael was taken to a bevy of New York pediatric specialists and an orthopedist, an occupational therapist, a joint-disease specialist, and a neurosurgeon.  At best, the bunch came up with “hypotonic,” meaning he had bad muscle tone.  But a real breakthrough did not come until his fifth birthday. 

Murray surfed a CD that came with a computer she had just bought  her son.  It had one segment called Family Doctor.  There she found out about Marfan’s Syndrome, a connective tissue disorder where all the symptoms matched Michael’s.  She had her suspicions confirmed at Mt. Sinai and Michael was put on beta blockers to prevent further enlargement of his aorta.  Affecting some 200,000 Americans, it is treatable, and if caught early, one’s lifespan can be extended from 40 to about 70.  Ms. Murray, president of menswear for Liz Claiborne, has since become a very active fundraiser for the National Marfan Foundation (www.Marfan.org).  

We would caution parents and patients that this is not an unusual situation.  No one better represents a patient’s interests than an informed patient or informed parent who will do all the random detecting that pernicious conditions demand.

133Abdominal Faults
Apparently 2 million Americans have abdominal aortic aneurysms, 90% of which are undetected.  Ruptures can result in death, and, indeed, some 15,000 people pass away from this complaint yearly.  A $200 ultrasound will identity the problem, but it is not a standard part of yearly physicals.  Treatment involves a wrenching operation, a long hospital stay, and a six-week recovery period.  Now surgeons are performing endografts, which are much less invasive, and where recovery occurs much faster.  Instead of replacing damaged sections, the surgeons insert a stent in the weakened area.  See Forbes, March 1, 2004, p. 111.

132. Norway Is Top Breastfeeder
“Today, more than three decades after bottle feeding peaked in the late 1960s, 99 percent of mothers here nurse their newborns in the hospital.  Six months later, 80 percent are still nursing, a rate that compares with 20 percent in Britain and 32 percent in the United States….”  “Studies have shown that babies who are breast-fed are generally healthier, suffering fewer colds, ear infections and stomach distress than babies who are given only infant formula.”  See The New York Times, October 21, 2003, p. A3.

131. Each to His Own Poison
Before antibiotics, salvarsan (a dose of arsenic) was perhaps the best treatment for syphilis, a discovery of Nobel prize winner Paul Ehrlich.  Some 19th-century scientists made much of the beneficial effects of small amounts of certain other poisons as aids to human health.  Poison, as a way to health, eventually lost favor in the scientific community, but is now slowly staging a comeback.  For instance, articles now claim that radon, in small amounts, may remedy various complaints. 

Of late, Professor Edward Calabrese of the University of Massachusetts has been further upending the canons of toxicology, as he discovers more and more cases that seem to prove that low dosages of many chemicals not only do not hurt the recipient but help promote growth, longevity, or better health.  “Hormesis is winning converts, however, as scientists decipher the mechanisms that underlie it.  Organisms respond to poisons by unleashing molecular repair crews....  Exposed to x-rays that tear DNA, cells produce enzymes that stitch it up.”  See The Wall Street Journal, December 19, 2003, p. B1. 

130. The Good Stuff
Back in the 1990s Roger Newton led the Warner-Lambert team that put together Lipitor, which today is the blockbuster anti-cholesterol drug (it is the market leader in statins) that has propelled Pfizer to the top of the pharmaceutical leagues.  Now he and others are pushing drugs that put good cholesterol into the body, instead of fighting bad cholesterol.  In fact, his company, Esperion Therapeutics, has just been acquired by Pfizer, which is at pains to protect its cholesterol franchise.  Statins only remove new accumulations of cholesterol on artery walls, but don’t do much about the plaque that’s already accumulated.  Other firms playing in the arena include Lipid Sciences, which is not as far along in its development, yet some claim its approach is ultimately more promising.  See Forbes, November 24, 2003, pp. 273-74.  In any event, the use of HDL or good cholesterol to put the coronary system to rights intuitively makes a lot more sense than the uncritical application of the much over-used statins.  At least in health, doing good is still a sounder premise than fighting evil. 

129. One Patient File
Increasingly, there are signs that your patient records will travel electronically with you from doctor to doctor, facility to facility, so that physicians will have a more adequate history when rendering your treatment.  A well-developed history, incidentally, is probably the key tool good physicians must have to reach an adequate diagnosis, to avoid wasting time and expense, and to avert fatal areas in several areas, to include drug prescription.  Afoot now is the CCR project (Continuity of Care Record), which is a cooperative project of the American Academny of Family Physicians (www.aafp.org), the Massachusetts Medical Society (www.massmed.org), ASTM International (www.astm.org), and the Healthcare Information and Management Systems Society (www.himss.org) wherein the standards have been set for recording medical information and the information protocols have been established that will permit transmission of information from institution to institution.  We ourselves would hope that such a record would also avert some of the promiscuous over-testing that we have observed at various facilities that lack data to understand what kinds of procedures and observations are merited.  See “Easy-to-Share Medical Records Gain Support, Would Cut Errors,” Wall Street Journal, November 20, 2003, p. D3.  On the one hand, we are enthused to read about such portability.  On the other, we wonder if this will discourage physicians in the healthcare chain from doing the long, adequate histories from which insight arises and which separates excellent doctors from the also-rans.

128. Finally Fatties Feeding Fresh
Americans are beginning, finally, to eat fruits and vegetables, according to study by NPD Group.  See Wall Street Journal, October 14, 2003, pp. B1 and B7.  And the number of people exercising vigorously is also rising.  Meanwhile and even more importantly, employers appear to be stepping into the battle against fat.  See “Fight Against Fat Shifts to the Workplace,” New York Times, pp. 1-18.  Sprint has a fitness center, forces employees to walk long distances from their cars to the office, and has slow elevators to get people to walk from floor to floor.  Union Pacific is providing employees with weight loss drugs to see if that would help in the battle of the bulge.

127. ADEAR
There are a few Alzheimer’s sites around, but we find this one as useful as any.  It is the Alzheimer’s Disease Education and Referral Center, an effort of the National Institute on Aging.  We learn that it is not only helpful for the afflicted and their families, but that some healthcare professionals use it to stay abreast of certain developments in the field. See http://www.alzheimers.org/.  So you can find out about ongoing clinical trials or relevant conferences if you are an investigator.  But families of patients can discover the 29 Research Centers around the nation.  You also can reach it at 800-438-4380.

126. Yoga on the March
As yoga gains more adherents in the West, particularly in leading edge urban areas, there are signs that at least smaller firms are beginning to make it part of the workplace.  See Wall Street Journal, October 14, 2003, p. D4.  This seems to include design studios, marketing boutiques, and the like.  Most interesting is the addition of regular sessions of yoga in the counseling section of the New York Fire Department, the staff of which has become particularly stressed because of the fallout from 9/11 and thereafter.  WSJ cites interesting growth numbers from the Yoga Journal:  it claims 15 million people are now active practitioners, with another 35 million claiming they want to try it over the next year.  Almost invisibly, a little bit at a time, a healthcare infrastructure seems to be growing up outside of our formal healthcare system to deal with the new hazards of an urbanized, technocratic, digital society.

125. Stress Ain't All Bad
Well, you know about the business executives that seem ageless and thrive on 16 hour workdays, but who drop dead a year into retirement.  It’s not clear that many of us do well when we give up the grind.  We have long known, when we have our wits about us, that both the mind and body need constant exercise (stress) to the end of our days if we are to have a life worth living. 

So it’s refreshing to read Gina Kolata’s (no, this is not a coconut drink) “May Your Days Be Long and Stressful,” New York Times, September 21, 2003, p. WK 12.  She comments on Dr. Mark Mattson, chief of the laboratory of neurosciences at the National Institute of Aging in Baltimore, who has been on a low calorie diet for 20 years, his regimen of no breakfast, light lunch, and consistent exercise keeping him at a light 120 pounds.  High stress, he says, kills, but mild stress is beneficial.  “Astonishingly, there is some evidence that even the stress of low-level radiation seems to make cells hardier, Dr. Warner (director of the biology of aging program at the National Institute of Aging) said, not that he or anyone else is advocating that you subject yourself to x-rays for your health.”

124. Breath and Chip Testing
“Researchers recently discovered that tiny molecules found in a single puff of your breath may help screen for a range of conditions, including asthma, cancer, and even schizophrenia.”  Michael Phillips, professor at New York Medical College in Valhalla, New York has been particularly active in this area, and he hopes to take his ideas commercial through his company, Menssana Research (www.menssanaresearch.com), in Fort Lee, New Jersey.  Aerocrine (www.aerocrine.com/) of Sweden now is out with FDA approved test for asthma.  Ekips Technologies (www.breathmeter.com/index.xml) in Norman, Oklahoma also offers an asthma breath test using lasers.  See Wall Street Journal, October 1, 2003, p. D10.  Meanwhile, the Genome Institute of Singapore (www.gis.a-star.edu.sg/homepage/default.jsp) has announced that it is working on a microchip it hopes to ready by January 2004 to test for SARS, dengue fever, and flu.  Nasal fluid or sputum would be put on the chip, and the chip would correctly identify the specific infection (Reuters, October 5).  Tests for many severe afflictions promise to become much less invasive and vastly less time consuming.

123. Ah, Dark Chocolate
The docs occasionally lend aid and comfort to our worst tendencies.  Our household likes dark chocolate, and there is some reportage every year or so that says it helps prevent heart disease, raising antioxidant levels in the blood.  Keep out the milk, say the researchers, because that gets in the way of the active health ingredient—the flavonoids in chocolate.  Most recently both Nature and the Journal of the American Medical Association (see August 27) talked of studies suggesting  possible heart benefits, though skeptics about chocolate’s efficacy do abound.  See the Wall Street Journal, August 28, 2003, p. D15. 

122Meditation for Body and Soul
Richard Davidson, a neuroscientist at the University of Wisconsin-Madison had been  hard at work demonstrating that meditation not only calms the emotions but that it also vastly helps one’s physical health.  More powerful brain scans show how the brain looks amidst meditation but also reveal “enduring changes in brain activity months after a prolonged course of meditation.”  It is particularly worth following Matthieu Ricard, a French monk and molecular biologist, who both investigates this area and participates in experiments relating to the impact of meditation.  (See www.beliefnet.com/author/author_43.htm.)  “Some experiments have … shown that greater left-sided prefrontal activation is associated with enhanced immunological activity by natural killer cells and other immune markers.”  “Since founding the Stress Reduction Clinic at the University of Massachusetts Medical School in 1979, Kabat-Zinn and colleagues have treated 16,000 patients and taught more than 2,000 health professionals the techniques of ‘mindfulness meditation,’ which instructs a Buddhist-inspired ‘nonjudgmental,’ total awareness of the present moment as a way of reducing stress.”  See “Is Buddhism Good for Your Health,“ The New York Times Magazine, September 14, 2003, pp. 46-49. 

The Massachusetts Institute of Technology held a recent conference on “Investigating the Mind,” which included participation by the Dalai Lama, Davidson, and sundry other scientists.  See www.investigatingthemind.org/about.sponsors.html.  This conference on September 13 and 14, 2003 was littered with interesting people such as Jerome Kagan, Daniel Kahneman, Eric Lander, and Matthieu Ricard.

121. End to Annual Physicals?
We don’t think so.  A silly, but well meant, article in the New York Times, August 12, 2003, p. D1 and D5, “Annual Physical Checkup May Be an Empty Ritual,” nonetheless provokes some other thoughts.  Because our own cancer was discovered at an annual physical, we are happily aware of the value of such checkups.  The article cites studies and also quotes doctors who question the value of these physicals and the ritual over-testing that goes with them.  In our eyes, all this merely indicates that internal medicine is much out of date, and the doctors need to be severely retooled to be more effective.  Recent articles about family practices in desolate agricultural areas reveal, for instance, that such visits allow sensitive doctors to practice a little cheap, informal counseling.  This is not inconsequential in a nation where the incidence of depression is skyrocketing.  Furthermore, the cost of tests should and can be brought down severely, and they can be administered elsewhere on a cheap, production line basis:  there is new equipment coming on line that can cost cuts severely, eating into the inflated fees charged by the labs.  Even in situations where all is nominally well, the doctors, as a result of testing and interviews, should afford each patient a written health plan at the end of the session (this could be computer generated as variables are typed in) that gets to the 2/3 of the nation that is overweight, the 80% that is working too much, etc.  By and large, the annual physical needs to be translated into an experience that prevents illness, not one that looks for the cows after they are out of the barn.  The same physical needs to be plugged into a continuous care regime that is mostly administered by less highly paid health workers.

120. Weighty Matters
As we have said here umpteen times, the nation’s biggest epidemic is obesity.  We’re steadily getting fatter, based on an obnoxious national diet, a lack of exercise since suburban living and land use design in newer areas of the country have taken walking out of our life, and compulsive overworking which throw all our good habits out the window.  The schemes abound for taking off our pounds, as everybody horns in with ideas for slicing off our flesh.  To get up to date on some of these, read “Obesity is the Target,” USA Today, May 8, 2003, pp. 1D & 2D.  Taxes on bad foods, hyper walking programs, more portion control, better food labeling, etc. are all ideas being bruited about.  As effective as anything is more conversation between those trying to take off a pound or two.  We ourselves find that we eat better, exercise more, etc. as we talk about the pounds with family members and with distant friends who are trying to melt away the flesh.  Again and again, we think, it has been demonstrated that addictive behavior, such as the panoply of bad habits that go into gaining weight, is best controlled by small, informal, close-knit personal networks in which all share a common problem and the common goal of getting out of the ditch and never returning. 

Interesting, however, is the effort of some agile companies to make their employees more fleet footed.  Abby Ellin in “Shed Some Pounds (and Get a Bonus),” New York Times, August 13, 2003, shows how various companies have incentivized their employees to lose weight.  VSM Abrasives formed 20 or so five member teams:  the team that lost the most weight “won $100 and a day off with pay for each team member.”  “At the Adventist Media Center in Simi Valley,” each employee got rewards for each mile walked or for every 20 minutes of exercise.  Richard Zanetti, “president of Yonkers Avenue Dodge … doubled employees’ monthly bonuses if they lost at least 10 percent of their body weight.”   

We are currently advising companies that the only way to reduce their healthcare costs in the American setting and to achieve major employee productivity improvements is to promote on-the-job, all-encompassing health programs that get at weight and other health problems in a major way.  Only preventive health measures will really get at our health costs, although continuous health programs for chronically ill patients that is rendered outside the hospital environment can also mitigate health expense.  Treatment programs, however, need to be divorced from preventive health programs.

119. Half Right
A recent team at Rand interviewed 13,000 patients and looked at 6,712 medical records at a cost of $6.5 million over a two-year period to determine that patients get the correct care only 55% of the time.  Inappropriate measures were widespread, involving heart and diabetes patients who would clearly benefit from more appropriate intervention.  Their projections surmised that perhaps 10,000 pneumonia deaths could be averted annually if vaccinations were given, and that good screening could prevent 9,600 colon cancer deaths. See The Wall Street Journal, June 26, 2003, p. D3.  For the Rand release on this study, go to www.rand.org/hot/press.03/06.25.html.

118. Less Prostate Surgery?
A new scanning technique in which patients are injected with an iron oxide agent has been shown to be much more sensitive than conventional MRI scans in tracking the spread of cancer into lymph nodes.  With prostate and other forms of cancer, the form of treatment is very much dictated by the degree to which the cancer has spread.  More precise mapping of the cancer can lead to more elegant treatments that are based on less guesswork.  The manufacturer of this agent, called Combidex, is Advance Magnetics (www.advancemag.com), which is still awaiting final approval from the FDA.  See The Wall Street Journal, June 19, 2003,  pp. D1 and D3.

117. Tara's Tests
Tara Parker-Pope of The Wall Street Journal has come out for 5 tests she thinks are lifesavers, even if your insurer won’t pay for them.  Transvaginal Ultrasound.  Ovarian cancer is a big killer of women, particularly because it does not show early symptoms  and there’s no regular, generally approved test for it.  Early detection results in cure rates of 95%.  Expanded Cholesterol Testing.  The usual testing does not directly measure LDL, which is the bad kind of cholesterol.  Nor will it look at the characteristics of your HDL and LDL, which are better predictors of heart disease.  She thinks the best test comes from Berkeley HeartLab of Burlingame, California.  EBT Heart Scan.  This test looks at calcium build up, another great predictor of severe heart problems.  Spiral CT Scan.  This is the right way, even with false positives, to look for lung cancer, even though it is not completely clear that detection will improve your chances of survival.  Aneurysm Scan.  This will spot abdominal aortic aneurysms, which are surprisingly common.  See The Wall Street Journal, June 24, 2003, pp. D1 and D4.

116. Cholesterol Only Half the Story
For years physicians who look harder at the data have told us not to over-rate cholesterol numbers in trying to find out if  patients were at risk for heart disease.  Now, finally, some medical personnel are demanding tests that go beyond the standard lipid-profile numbers which may exaggerate or gloss over the heart risk of this or that patient.  But now we learn as well that one should pay a lot more attention to “inflammation of  blood vessels.”  “Americans’ arteries are not just clogged—they’re swollen.  …  Half of all heart disease patients don’t even have high cholesterol.  …  Swelling of vessel walls causes cholesterol plaques to rupture.  A clot forms around the loose gunk, creating a blockage that starves the heart of oxygen….”   

“But one company, the tiny AtheroGenics, has a pill that promises to save lives by reducing the swelling.”  This “experimental drug, AGI-1067,” is finally in late-stage clinical trials.  What appears to happen is that the drug prevents LDL (bad cholesterol) from oxidizing and sticking to vessel walls.  It is the adherence that seems to produce the undesirable inflammation.  See Forbes, June 23, 2003, pp. l68-69.

115. Watch Out for Paxil
“British drug regulators” have warned that GlaxoSmithKline’s “popular antidepressant Paxil causes depressed children to become more suicidal and should not be prescribed for them.”  See New York Times,  June 11, 2003, p. W1.  Glaxo is not providing warnings on the drug in the United States, where it is authorized for use with obsessive-compulsive children.  Paxil is part of a class of drugs such as Prozac and Zoloft in which such side effects seem to be a problem.  We note, in general, that there often is not enough test data, positive or negative, for children on the application of a wide range of drugs for sundry psychological problems.

114. Dealing With Stress Now
There’s a shift in thinking about how to handle stress.  The temptation is to postpone relief, as we tell ourselves we will relax this week end or go to yoga tomorrow morning.  The problem, say researchers, is that you must deal with stressful events as they happen if you really want to minister to your health.  For instance, some companies now provide biofeedback equipment that allows you to test your stress level at any moment:  with practice, some employees can bring down their stress numbers in minutes when they have reached unacceptable levels.  Other helps for immediately dealing with stress apparently include more calming office furniture, breathing exercises, appropriate snacks, and  philosophical training that breeds a better, more relaxed attitude towards shattering  events.  See the Wall Street Journal, March 11, 2003, pp. D1 and D5.

113. Beyond Statins
Amongst the most profitable drugs in the armories of the pharmaceuticals are statins, which have proven terribly effective in lowering lipid profile (cholesterol) numbers in major segments of the population in the developed world with relatively minor side affects (apparently).  We ourselves helped one statin developer bring its product to market.  That said, we remain worried about the side effects not yet discovered, theorizing that anything that has so dramatic an effect on the blood must be having other bodily effects we have not gauged.  Of course, our heart man (we have one, even though we have no apparent heart problems) thinks it is silly to worry about this when you get old enough:  one will be under the sod from something else long before the hidden problems in statins can do their worst. 

Niacin does offer some hope for those with elevated cholesterol, but it does not have the dramatic impact on one’s numbers that ensues when you take the statins.  We are trying out a natural supplement called policosanol about which we should caution you:  there is simply not enough data to say that it is either effective or safe.  Some of the houses that peddle it make some giant-sized claims about the good things it will do for those who use it, and these endorsements have to be discounted.  On the other hand, we know doctors who are using it and who are convinced of its merits.  You can read about it at  www.lef.org/magazine/mag2001/june2001_cover_policosanol.html?GO.X=7\&GO.Y=15 and can find other things about it at the www.lef.org website.  But, again, we caution you that it has not been accepted by cardio doctors, and we need a lot more data before we can weigh its merits.

112. Kicking the Habit
The Internet now offers a number of sites that help people trying to kick the habit.  Very structured is Smokeclinic.com.  The most popular apparently is Quitnet, the members of which turn out to be quite supportive to those trying to pass up the smokes.  Other sites are Lungusa.org and Trytostop.org.  See Wall Street Journal, April 22, 2003, p. D1.

111. Sheer Waste
If you can bear the dense writing, you will find some eye-opening insights in these articles on Medicare.  We refer you to “The Implications of Regional Variations in Medical Spending, Parts 1 and 2,”  The Annals of Internal Medicine, 18 February 2003, Volume 138, Number 4, pp. 273-299.  Also see the relevant editorials in the same issue, pp. 347-351.  “Regions with higher expenditures did not provide better quality of care on most measures.”  “Regional differences in Medicare spending are due almost entirely to use of discretionary services that are sensitive to the local supply of physicians and hospital resources….”  “If the United States as a whole could safely achieve spending levels comparable to those of the lowest-spending regions, annual savings of up to 30% of Medicare expenditures could be achieved.”  “Most important, the second of the two articles by Fisher and colleagues … demonstrates that patients in high-spending regions had no better survival (if anything, slightly worse) than those in lower-spending regions.”  In other words, there is something like a quarter of a trillion dollars we could be spending on something useful if we could get the make-work out of the  Medicare system.

110. Fat and Cancer
“Losing weight  could prevent one of every six cancer deaths in the United States,  more than 90,000 each year….  Researchers for the American Cancer Society spent 16 years evaluating 900,000 people….  The researchers concluded that excess weight might account for 14 percent of cancer deaths in men and 20 percent of those in women.”  See New York Times, April 24, 2003, p. A23.  “The study doesn’t answer the question of why there is a link between obesity and death from cancer….  [I]nvestigators have been unable to pinpoint a biological mechanism clearly linking obesity to most forms of cancer.”  See Wall Street Journal, April 24, 2003, p. D3 and current New England Journal of Medicine.  Eventually we will have to understand whether the cancer is caused by weight in itself or by certain noxious elements in the kind of foods we eat.

109. Take Tea and See
A component in tea, L-theanine, has been found to bolster the body’s immune system, warding off bacteria, viruses, and fungi.  Dr. Jack Bukowski, researcher at Brigham and Women’s Hospital in Boston, said five cups of tea a day strengthened the body’s disease defenses.  “The health effects of tea have been extensively studied.  It has been linked to lower incidence of heart disease and cancer risk through the action of flavonoids, a type of antitoxidant.  Other studies have linked tea to helping combat osteoporosis, the brittle-bone disease, and to relieving some allergy symptoms.”  See Wall Street Journal, April 22, 2003, p. A12.

108. Down and Out
On this section of our website, we largely make the argument that health in these United States and around the world can improve by leaps and bounds if we can implement decent preventive health measures either through public health channels or through motivated private sector initiatives.  We think private foundations probably will not get much done about health, whether we are talking about the Rockefellers or the Melissa and Bill Gates Foundation:  they mean well but they suffer from whom they are.  Putting all this aside, some think that large-scale improvements in health are more driven by initiatives in the social and political sphere that seem unrelated to healthcare than by all our tinkerings with health policy.  If this is true, we would focus less on health policy and more on issues like income distribution, public infrastructure, etc.   

This view  comes down to the idea that down and out people don’t have much of a chance to be healthy.  On the one hand, in societies that consume too much and that are torn by income disparencies, there is little resource left over for health.  And, on the other, the poor and stressed lack family cohesion and social amenities that are part of the fabric of health, particularly as relates to mental wellbeing. 

This is well related in The Health of Nations by Ichiro Kawachi and Bruce P. Kennedy, published in 2002.  For the stressed and depressed who have no time to read, we would particularly recommend a review of this book we caught in the New England Journal of Medicine (January 2, 2003) by Stephen Bezruchka at the University of Washington School of Public Health and Community Medicine: 

“The Health of Nations presents evidence from many disciplines that political policies that widen inequalities in income may harm a nation's health.  Kawachi, an internist turned social epidemiologist, and Kennedy, an educational psychologist  present arguments to show that one's relative position in society is more important than absolute wealth or income, not only when it comes to general well-being, but in terms of mortality as well.” 

“We work harder and longer just to keep up with our 1973 standard of living.  This additional work translates into 5 to 10 more weeks of work each year for members of the American labor force than for their European counterparts.  Politicians preach about "family values," but how can families prosper without time for maintenance?  As a result of the orientation toward individual rather than family needs, some people see children as obstacles to individual growth. The authors point out that higher rates of crime occur when the high cultural value placed on competitive achievement clashes with widespread disparities in actual living standards within a society.  Inequality is harmful, and we pay the ultimate price for it with premature deaths.” 

“To improve health in the United States or elsewhere in the world, we must address factors that affect the health of populations but have only indirect relevance for patient care.” 

We ourselves probably regard this point of view as interesting but a distraction for health care professionals.  We do think the decline in the standard of living the nation has suffered since the Vietnam War and the rise in stress occasioned by every employee doing the job of two have brought low the health and welfare of the American community.  Nonetheless, we feel that massive, direct changes in the healthcare system could ratchet American health upwards even with the societal problems cited by the authors.

107. Executive Checkups Pay Off
A study of Bank One executives in the August issue of The Journal of Occupational and Environmental Medicine found that executives who had systematic deluxe checkups had 20 percent fewer health claims and 45 percent fewer workday losses than those who didn’t.  Lillian Vernon Company in Rye, New York has noted a drop in executive absenteeism since it instituted these exams, and finds that the checkup is also a good talking point when trying to attract new talent.  Lincoln Plating in Lincoln, Nebraska calculates that lower claims costs, etc. more than pay for the examination program.  In 2002, moreover, the company had no increase in health insurance premiums and now is expecting only a 15 percent bump, less than the 25 percent jump many companies are experiencing.  See New York Times, March 25, 2003, p. BU12.

106. Time Out Saves Lives
“A lack of vacations was a predictor of heart attacks and early death among 740 women studied over 20 years, says a landmark study published a decade ago in the American Journal of Epidemiology.”  See Wall Street Journal, March 27, 2003, p. D1.  Sundry other surveys and research, says the article, show vacations have a big health payoff.  Moreover, the U.S. and Japan have mandated vacations that are as short as 10 days, with Denmark on the other hand putting its workers out to pasture for 30 days.  Incidentally, even the animals at the Copenhagen Zoo get a vacation, since they are sent to a retreat outside town to get away from peering people:  this fact is not cited in the article.

105. The Hidden Costs of Sickness
Dr. Ronald Kessler and his colleagues at the Department of Health Care Policy, Harvard Medical School, are exploring the true costs of illness of our working people.  There are estimates that the cost of bad health is 2 to 3 times the expenditures employers expend for health benefits  We even think the cost is much higher.  In any event, those tracking the costs of bad health will want to read Dr. Kessler’s “The Effects of Chronic Medical Conditions on Work Loss and Work Cutback,” The Journal of Occupational and Environmental Medicine, Volume 45, Number 3, March 200l.  The methodology for researching such questions is difficult and such an inquiry does not even cover all the incidental costs outside of benefits that are related to employee illness.  Be that as it may, “the estimated average per capita number of work-impairment days in the total sample is 1.5 per month.  This is equivalent to an annualized national estimate of over 2.5 billion work-impairment days in the age range of the sample.”  Apparently the estimates here are not out of line with other informed guestimates about the same sort of questions.  What this implies is that new efforts to deal more systematically with chronic illness, while affecting the national health bill positively, are not draconian enough to deal with the employer’s dilemma.  With all these indirect costs, only continuous, intensive wellness programs will really get to the meat of the matter.  No smart employer will simply focus on benefit costs and ignore the true dimensions of its healthcare bill:  the forward-looking company must struggle with absenteeism and lost productivity as well.

104. Ancel Keys and More
Henry Blackburn’s “On the Trail of Heart Attacks in Seven Countries” is an absolutely fascinating tale about Ancel Keys of the University of Minnesota who put together a multi-country team to study habits and heart disease in 7 countries.  Certainly this has to be the best read on any public health website anywhere in the country.  See www.epi.umn.edu/epi_pages/research/Foreword and www.mbbnet.umn.edu/firsts/
blackburn_h.html.  When Keys posited to the potentates of the heart community that altering behaviors was the right way to get at heart disease, all the wise men of the cardiology community scoffed.  Stunned, he went into action and put together a team that looked at the relationship of eating habits, smoking, exercise, etc. to heart disease.  Lo and behold, the study uncovered all we know today yet have been so slow to apply.  Getting a few things right can massively lower coronary problems, as best evidenced by Finland where very intensive public health activities have sliced heart rate problems by twenty percentage points or so.

103. Murdered Sleep; Stealing Naps
“William Dement, founder and director of the  Stanford University Sleep Research Centre, reckons that people on average now sleep one-and-a-half hours a night less than they did a century ago, at great cost for their health and safety….”  Experts seem to think most of us need around 7 hours a night.  “Several great men who claimed to need little sleep, including Napoleon, Edison and Churchill, got by on their ability to nod off briefly whenever they had the chance.”  It’s felt that short naps, of perhaps a half hour, may be very beneficial.  We know more than a few executives who keep a couch in the office and sneak a respite during the day.  In this tiring world, we ourselves see naps as the only realistic solution to the fact that we must burn the candle at both ends.  See “And So to Bed,” the Economist,  December 21, 2002-January 3, 2003, pp. 111-113.  And to catch up on Dr. Dement, go to www.sleepquest.com/index.html.  We like him best for his endorsement of dreaming:  “Dreaming permits each and everyone of us to be quietly and safely insane every night of our lives.”

102. The North Karelia Project
Thirty years ago North Karelia, a poor area of Finland, suffered from twice as much heart disease as the rest of the country.  Then a public health official, Dr. Pekka Puska, took it in hand and proved that miracles do happen.  To the people of Karelia he pounded home the virtues of eating more vegetables and getting rid of the fat, of exercising lots more, and of cutting back on smoking.  Over the last 3 decades, the province has slashed the number of heart attacks, the number dying from heart disease, and the number dying from lung cancer by about 70%.  For men eight years have been added to life expectancy, and six years for women.  The program has been expanded to the rest of the country with equally dramatic results.  Read more about this under Finland Power in our Big Ideas section and in our Letters from the Global Province, 5 March 2003, “My Favorite Year.” Puska has moved onto WHO, so we hope he can begin to work his magic around the world.  See the Wall Street Journal, January 14, 2003, pp. Al and A16.

101. Pollution Centers
“During the last decade, the country’s pollution center has shifted from the industrial Northeast and Midwest to the South.  Thirteen Southern states, stretching from North Carolina to New Mexico, were responsible for producing nearly half of all toxic releases known to produce cancer.”  Obviously, this article in the Wall Street Journal, January 23, 2003, p.D3, should have said South and Southwest.  The U.S. Public Interest Research Group at www.uspirg.org has led the effort to single out high pollution zones, zip code by zip code, and codify the link to human disease.  There are bills before Congress to track chronic diseases and to relate their occurrence to environmental factors such as pollution.  To get specific readings on pollutant dispersals in your state, go to http://uspirg.org/uspirg.asp?id2=8822&id3=USPIRG&.

100. Open for Business
Almost a decade ago, Heineken operations in Rwanda were ravaged by genocide growing out of tribal warfare between the Hutus and the Tutsis.  Half its brewery staff was killed, and it took 3 year to put things right.  Now HIV/AIDS threatens to close the brewery again, as the death toll mounts.  Trained, literate workers are hard to come by.  In self defense, Heineken has guaranteed anti-retroviral drug coverage for workers and their dependents.  Heineken operations in Africa enjoy very high margins, and the company can ill afford the loss of revenues and profits garnered there.  See Forbes, February 3, 2003, pp. 64-66.  Africa demonstrates in stark clarity what is just as true in Western developed countries: if unmanaged, health costs and related absenteeism saps the profitability of multinationals at virtually all their locations.  For this reason, Disease Management Programs are growing at employers throughout the United States, enjoying exceptional growth in 2002.  For more on this, see Business Week, October 14, 2002, pp. 122-24.

99. Fat City
Houston again tops the fattest city list.  Every year Men’s Fitness ranks the cities that will make you fat, and those that will make you fit.  Bummers are Houston, Chicago, and Detroit.  Blessed are Honolulu, Seattle, and San Francisco.  For a complete list, see www.mensfitness.com/mens/superfeat/010203/ranking.html.  In general the West is the place to be, while the South and Southwest do a good job of fattening you up for slaughter.  We ourselves noticed how easy it was to gain weight when we moved from the West to East Coasts, or even from the Southwest to the South.  It’s largely a function of exercise and diet, though some cities have special aspects of their culture that put pounds on or take weight off.  As we have shown elsewhere, where you live has a lot to do with how healthy you are.

98. Drugs from Monsters
Useful substances are now being gathered from some of nature’s frightening creatures—gila monsters, bats, scorpions, puffer fish,  leeches, and poison-dart frogs.  Insulin regulation, blood clotting, pain relief, and a host of other benefits apparently can flow from the poisons of these unattractive creatures.  See “Medicine’s Wild Kingdom,” Business Week, February 3, 2003, pp. 70-71.  Here is yet another example of where nature provides remedies that would save lab researchers a lot of work.

97. Richard II
Richard Saul Wurman, creator of Access Guides to sundry cities, re-organizer of the Yellow Pages for the Bell companies in San Francisco, and, most of all, impressario for TED (Technology, Entertainment, Design), a conference where he brought out media and Silicon Valley moguls to brag about their wares and charged very hefty ticket prices to attendees, is now on to his next act.  Do we call it Richard II, III, IV, or V—who knows?

Now it’s to be TEDMED, scheduled for June 11 to 14 in Philadelphia.  The grand goal is to make medicine, especially new trends in medicine, understandable to us all.  So he’s going to take complicated diseases and make them  simple.  Obviously, he is on to something, because a host of clever people believe that health information is the key to better healthcare at lower cost, be it timely information accessibly stored for doctors, or well-presented information understandable to all patients about disease and disease treatments, or better exchange of data on billing throughout the whole cumbersome healthcare administrative apparatus.  In fact, he’s the latest participant in this burgeoning information market.  See Forbes, January 6, 2002, pp. 160-161.

96. Body Mass
As if you did not know, you are probably overweight.  But here’s how you get your Body Mass Index straight, according to The New York Times, December 17, 2002.  Divide your weight in pounds by the square of your height in inches.  Multiply the result by 703.  If you get a figure of 25 or above, you are merely overweight like me.  If, however, it is 30 or higher, you are obese and probably should worry about it.  Ostensibly your risk of stroke, for men anyway, increases 5 or 6% for every additional point on the BMI.

If you are lazy like me, which is probably the reason why we are both overweight, then go to this site of the National Heart, Lung, and Blood Institute. You can come up with your mass without doing weighty calculations.  In other words, you will not have to do the complicated math we laid out in the paragraph above.  Just plug in a couple of numbers, and presto.  See www.nhlbisupport.com/bmi/bmicalc.htm.

95. Self-Help in China
Dr. Hong Zhaoguang has a self help health message that has captured the mind and hearts of China’s millions and China’s ministers.  His books are bestsellers; his lectures 3 or 4 nights a week are attended with rapture, and he is now joint chief lecturer for 11 ministries. A cardiologist by training, he has put together his own formulary of preventive medicine which basically consists of telling people to take care of themselves in very simple language.  For instance, there are four bests:  the best doctor is you; the best medicine is time; the best state of mind is peace; and the best exercise is walking.  See The New York Times, December 21, 2002, p. A4.  In China, too, there is a growing realization that the only prescription for a growing healthcare crisis is to change people’s behavior by motivating individuals to take up the cudgels for their own health.

94. Unhealthy Vaccines
A Danish study at the University of Aarhus appears to document a connection between treatment with vaccines and autism in children.  See the Wall Street Journal, November 7, 2002, p.D4. Even more disturbing, Neal Halsey, a physician and scholar at John Hopkins and onetime chairman of the American Academy of Pediatrics’ committee on infectious diseases, who has long been a strong vaccine advocate, is now rather persuaded of its dangers.  The culprit may be thimerosal, a preservative that apparently contains more mercury than a child should have to tolerate.  See “The Not-So-Crackpot Autism Theory,” New York Times Magazine, November 10, 2002, pp. 66ff.  Now the mercury has been removed from vaccines, which are crucial to any kind of public health effort and are the best hope, actually, for lowering health costs in large populations, particularly with the advent of many new vaccines, such as those for cancer.  There is acute resistance, we should note, in both the scientific and medical community to the idea that vaccine formulations could be the basis of autism or neurological disorders.  Nonetheless, it only leads one to suspect that several of the neurological complaints that tax broad numbers of people as they grow older may often have a chemical basis stemming from substances ingested into the body in one manner or another. 

Fortunately this and other problems with vaccines probably will not put a damper on vaccine growth, as R & D and new products pick up.  The economics of vaccines have become compelling, not just for the big pharmaceuticals, but for public health administrations around the world trying to get a grip on healthcare costs.  It’s simple:  preventing a problem is a whole lot cheaper than trying to cure it.  Global sales of vaccines have been limping along at $6 billion annually, a drop in the bucket.  Merck’s HPV vaccine, Glaxo’s herpes preventive (now in development), and Wyeth’s Prenar for pneumococcal bacteria  promise to bump up vaccine sales considerably, according to Business Week, December 9, 2002, pp.40-42 in “Vaccines are Getting a Booster Shot.”  Despite the fact that the number of companies selling vaccines has shrunk to 4, more than 100 vaccines are working their way through the labs.  If we can secure better global distribution of vaccines, thereafter, it bodes well for global health.  We ourselves remain passionate vaccine advocates—with a wary eye.

93. More Back Up on Back Pain
We have just put up one note on back aches (see item number 90).  This is an affliction  which deserves quite a bit of study, since the costs for society are huge. You will discover that back afflictions account for a stupendous number of medical visits when you look at medical plan statistics.  Well, the Wall Street Journal has cultivated a resident backologist in the person of Ms. Tara Parker-Pope, who has written convincingly on the topic on more than one occasion.  We can only suspect that upright chairs at Dow Jones or the stresses of life have knotted up her own back.  At any rate, it is worth consulting her Health Matters column of September 30, 2002, p. R6, which is authoritative and does cover a range of options.  She notes that 250,000 spinal fusions are done each year, and that only 50% work.  Moreover, as she says, 90% of all back problems get better in 3 months, so one should not rush to extreme treatment.  Among the options she discusses are injections, therapy and exercise, heat procedures, less-invasive fusion surgery, and total disk replacement.  As interesting is a follow up on November 12, 2002, p. D1, entitled “In Excruciating New Cure for Back Pain, Doctors Tell Patients to Hit the Weights.”  Here she comments, “A number of recent studies show back-pain sufferers who use aggressive exercise are far more likely to return to work, have less pain and are less likely to seek additional back treatment than those who use more traditional treatments.”  We are discovering  that benign neglect and/or exercise deal with many of the body’s painful complaints.

92. A Better Hospital Stay
Laura Landro’s “The Informed Patient” should be a regular read for those managing their own healthcare.  Ms. Landro has had a couple of bouts of illness herself and knows whereof she speaks.  A recent column, “Sick of the Hospital Treatment?  New Forums Let You Rate Care” (Wall Street Journal, August 1, 2002, p. D3) gives some very sensible advice on how to be a successful advocate if you are hospitalized.  She says:  Have a friend with you as often as possible to see that the right things are done; request all the information on your case to include charts and clinical data; don’t leave the hospital without clear instructions as to how to care for yourself at home; find out if the hospital has a patient ombudsman in case you do have to complain.

91. For 80 Cents More
A recent experiment in Tanzania showed that extraordinarily small additions to the public health budget could net tremendous benefits, as outlined in a special report in the Economist (August 17th, 2002, pp.20-22).  In part this is due to the fact that so little of the national health budget actually goes into patient care.  For instance, for every $100 spent on drugs, patients actually only received $12 in benefits for a host of reasons.  But, as importantly, the budgets often are targeted on the wrong diseases and conditions.  Malaria, for instance, often accounts for 30% of the problems, but only gets 5% of the funding.  Tuberculosis is only a 4% problem, but may get 22% of the budget in some regions.  Oddly enough, the data seems to show that vaccinations also swallow too much of the budget.  In the districts where the test was conducted, the results were spectacular with infant mortality numbers falling some 28%, for example.  Incidentally, this failure to prioritize is just as much of a problem in developed nations where, again and again, resources are not allocated well enough to chase the biggest problems.   Here and there, these days, there is a effort to intelligently segment populations by kinds of health problems in various parts of the United States in order to better understand how medical dollars should be focused, region by region.

90. Oh, My Aching Back
One of the areas where a more rational health system might achieve substantial savings is in the care of backs.  A huge percentage of the population has back pain, and its cost to employers and insurers, when you include medical expense and missed work days, may range as high as $45 billion.  We still don’t know how to deal with it, but it is at least interesting to know that one should be restrained about treatment since outcomes are uncertain and that one should realize that treatment options have evolved a great deal over the last ten to twenty years.  Forbes (August 12, 2002, p.123) has a very good short article about some of the options, including a newish heat treatment that, in effect, eliminates problematic discs.  Most importantly, the article notes, “nine out of ten sufferers will get better in six to eight weeks by exercising and taking an occasional pain pill.”

89. Celexa (Cipramil)
“A CEO and His Son” is the remarkable story of how Howard Solomon of Forest Laboratories (NYSE:FRX; www.frx.com), seeking a cure for his son’s depression, brought a Danish anti-depressant to America,  which has turned out to be a blistering commercial success.  See Business Week, May 27, 2002, pp. 72-80.  Probably this is the most affecting story that Business Week has ever written.  Historically it has been a boring business magazine, even though it has been pretty good at early spotting significant trends and important commercial developments.  Susan Berfield, the writer, includes sidebars on how depression has affected famous persona such as Winston Churchill, Cole Porter, and Abraham Lincoln.  Snippets from his son Andrew’s movingly candid book about depression—The Noonday Demon:  An Atlas of Depression—lend extra dimension, even irony, to this business success story.  Howard Solomon had taken a small company out of vitamins and candy and into generics.  But in 1995 he contacted H. Lundbeck, a company in Copenhagen, whose drug had seized a 50% market share in Sweden, yet had failed to penetrate the U.S. market.  With single-minded dedication, Forest captured a big chunk of the American anti-depression dollar, accounting for 17.5% of new prescriptions today, with Celexa becoming the fast-growth drug in its category.  What sets it apart from Zoloft, Prozac, and all the rest is that “it is well tolerated,” its “side effects are minimal.”  While this is not a trivial distinction, it makes one realize that the success of the drug is due more to the focus and agility of a small company that had to succeed than to its therapeutic properties.  Andrew, incidentally, does not take Celexa, having found a cocktail of other drugs that works well for him.  Again and again with medical problems, we find that something new and different happens when a sufferer with smarts, or somebody related to a sufferer, takes up a disease and determines to do something about it.

88. Wash Your Hands of It
“The second-biggest killer of children in the world is neither malaria, nor tuberculosis, nor AIDS.  It is the runs.  Diarrhoea [sic] kills the equivalent of a jumbo-yet full of children every four hours” (Economist, July 6, 2002, p.80).  Even in rich countries, young and old do not wash their hands as often as they should.  Valerie Curtis at the London School of Hygiene and Tropical Medicine thinks hand-washing could cut diarrhea-like diseases 43%.  The problem is to get people to wash.  A partnership between the public sector (sanitation experts) and the private (soap-makers and the like) is producing some results.  “The health experts are bowled over by the marketing prowess that the companies are bringing to the project.”  This is the problem of the public health sector in microcosm.  It knows many things people should do in order to stay or to get healthy.  But neither public health officials nor the medical establishment knows how to sell its well-researched ideas.  In fact, so much of health is a consumer marketing problem, a process not understand by non-profits.

87. Bored to Death
“People who struggle to stay alert in boring, passive jobs are 33% to 35% more likely to die prematurely than those who have more active jobs….”  This conclusion is offered by Benjamin Amick of the University of Texas after studying data on 5,000 families collected between 1968 and 1992.  Stress arising from boring jobs apparently leads to drinking, smoking, lack of exercise, and other bad health habits.  See Business Week, July 1, 2002, p. 16.

86. Doctors Online
Medem, Inc., a for-profit outfit out in San Francisco, now offers online visits with doctors, with payments made immediately by patients via credit card.  Apparently this service has backing from the American Medical Association.  What’s different is that the consult is with a doctor already known to the patient; the online feature just adds flexibility to an existing relationship.  Other services have offered chats with doctors previously unknown to the patients.  Whatever the merits or demerits of this service, it is clear that retail, online health services with some sort of regulatory controls are vital if we are to control medical costs and simultaneously offer patients something they clearly want.  Consumer use of the Internet for health inquiries is rocketing.

85. MigrainesNerves, Not Blood
For years doctors have theorized—wrongly, it seems—that migraine headaches stem from constricted or dilated blood vessels.  This is a matter of some consequence, since migraines affect a large part of the population, particularly women.  Dr. Peter Goadsby at the Institute of Neurology in London, in brain imaging studies,  appears to have shown that “nerve cells in such areas as the visual cortex”  “fire off wildly,” with headaches resulting.  Anti-convulsant drugs such as valprorate and gabepentin are being pressed into service, as a consequence, with good results, though the search is on for better drugs with less side effects.  See the Economist, June 8, 2002, p. 75.

84. Obese in America
The Wall Street Journal (June 13, 2002, pp. B1 and B9) has begun a chain of stories on obesity, noting that companies with fat foods are beginning to realize they may become targets for disease prevention experts and others.  Further the WSJ posits that the Federal Government may have to revise its food pyramid which still may put the wrong foods in our diet.  “Obesity resulted in 300,000 deaths and some $117 billion in healthcare costs in 2000.”

83. Siesta
Researchers at Harvard seem to have proven that worker performance improves dramatically when a midday nap is included in the daily schedule.  Short nappers did as well on perception tests in the afternoon as in the morning.  Long nappers (60 minutes or so) actually improved in the afternoon.  This is a reinforcement of what we learned a half century ago with Bell’s telephone operators:  their performance improved when they were given timely breaks from the job.  Likewise, even the best of runners do better when they interrupt their runs with walking sessions, a healthy idea for new runners and for marathon runners who are in training.  See the Economist, June 1, 2002, p. 76.

82. Evidence-Based Medicine
The New York Times Sunday Magazine (May 5, 2002) tucked a very useful, very well-authored article about evidence-based medicine in its Medicine 2002 issue called "What Doctors Don't Know (Almost Everything)” by a practitioner named Kevin Patterson.  It appears in the context of an American society that overpays for overtreatment, excess hospitalization, and reckless over-pill prescribing.  What the doctor says is that received tradition has doctors pushing the wrong treatment for several illnesses, not paying attention to the strong medical evidence at hand.  Increasingly the same evidence, better dispersed, is equipping patients to push for better medical decision-making and overturning the unquestioned authority that many doctors enjoy with their patients.  But the article is also temperate:  while coming down for more evidence-based medicine, it also accents the role of intuitive doctors in better treatment, in effect saying that we still very much need experienced internists with good gut hunches both to do the right thing and to avoid unnecessary and sometimes deleterious treatments.

81. Prostate-Cancer Reading
Invariably the best advice on afflictions comes from the afflicted, if we catch those sufferers who are blessed with brains.  Interestingly, two of the best articles on prostate cancer appeared in Fortune, which oddly enough does occasional good health articles even if it has lost its business cachet.  Health also is a forte of Fortune's crosstown neighbor, The New Yorker, which does arresting medical articles about all the gray questions of disease, often making use of the pens of very talented Boston doctors.  For those going into treatment, Andy Grove's “Taking on Prostate Cancer” is a fine reading, showing how the former Intel chief executive got all the literature and eventually took himself to Seattle for his chosen treatment.  (As an aside, we must note that our medical informant tells us Andy took the wrong route, but he is still alive at the end of the journey).  See Fortune, May 13, 1996, pp. 55-76.  Benign neglect is often the right course of treatment, since you will often be dead of other causes before some of the slower acting prostate cancers can do you in.  Tom Alexander, one-time Fortune editor, came back for a reprise in "One Man's Tough Choices on Prostate Cancer," where he recounts how he elected to do nothing but watchful waiting.  See Fortune, September 30, 1993, pp. 86ff.  Apparently, prostate cancer is the second biggest killer amongst men.  Fortunately, the tests are improving, and we can expect a replacement for today's widely used PSA.

80. Closing the Barn Doors After The Cows Are Plain Gone
75% of all those online and 50% of all adults have looked for health information online.  Now the doctors are trying to get control of the process, trying to find ways to steer their patients to approved, medically vetted information.  This is probably a hopeless task, now that patients have gotten used to going their own way and medical authorities have been slow to get online with awkwardly stated and often fragmentary information.  A leader in the doctors' cause has been non-profit Healthwise (www.healthwise.org) which has distributed millions of handbooks and now has moved its so-called "evidence-based" database on line.  A host of plans do use Healthwise.  On the other hand, it is noted that often more of the information in approved databases is not up to snuff.  See "If Doctors Prescribe Information, Will Patients Pay or Surf Web," the Wall Street Journal, April 25, 2002, p. D4.  The approved databases will have to learn a whole lot about how to make their information much more user-friendly and how to mention approaches that may show some promise even if all the test data is not in.

79. Aspirin and Colon Cancer
Dr. John Baron of Dartmouth Medical School and his colleagues have found that the baby aspirin many oldsters are now taking every day is doing more than putting heart attacks on hold.  His study finds that the aspirin also seems to inhibit cancerous polyps in the colon, a meaningful finding since polyps appear to crop up in half of those over 60.  We would suppose, too, that researchers know much more about the side effects of aspirin than that of statins, which are now so enthusiastically over-prescribed by every internist in America.  See the San Francisco Chronicle, April 8, 2002.

78. Yet Another Fear of Flying
It is not very advertised, but deep vein thrombosis (D.V.T.) is a threat for anybody who flies a lot and who flies far.  Senior Bush’s vice president, Dan Quayle, was hospitalized for this kind of thing.  Basically when you sit too long, the blood clogs up, notably in the legs, and wretched things can happen.  For years we have been doing stationary exercises put forward by Lufthansa in one of its handouts.  And we walk around as often as possible, but at least once an hour, despite the airlines' passion for chaining us to our seats.  This is just one more advertisement for the need to exercise at all times.  See "Hidden Danger of Long-Haul Flying, or Sitting."  See the New York Times, April 16, 2002, p. C6.

77. Costa Rica Lives
Costa Rica has always been remarkable, because it is one of the more insistently democratic countries in Latin America.  Somehow it caught the habit of both democracy and long life.  “Though not a rich country, life expectancy in Costa Rica (at nearly 77 years) is not only the highest in Latin America but higher than Denmark’s.”   The U.S. and others must eventually investigate how certain countries, particularly a Costa Rica, deliver health with few dollars and without all the wonders of medicine enjoyed by the countries of the North.

76. Ornish on Prostate
Dean Ornish, the University of California (at San Francisco) medical professor, has made his mark using low-fat diets to treat heart disease.  Now he is out with a study, admittedly very small, that says low-fat may control or reverse prostate cancer, having noted that participants had lower PSA scores after 3 months on the diet than a control group.  Other physicians even think a low-fat diet may actually help prevent prostate cancer.  If these results are borne out in larger studies, such a treatment would be quite applicable to the large number of prostate cancer cases where the cancer actually advances at a slow rate.  Fast-growth cancers would still require surgery and/or other treatments.  See the Wall Street Journal, April 11, 2002, p. D8.

75. Fat Chance
What are your chances of being overweight?  In the U.S., some say 30% of our population is over the barrel, but tougher critics say 70% of our population is overweight and out of shape.  But you don't have to come from a nation of fat cats to tip the scales.  At a recent meeting of the American Association for the Advancement of Science, presenters declared that developing nations are catching up, with 100% of the population overweight in some zones.  In one large sample, 12% of India's women were found to be too ample.  As we've said elsewhere, obesity is the world's biggest epidemic.  See the Economist, Feb. 23, 2002, p. 81-82.

74. Learning Not to Eat Anything
CSPI (Center for Science in the Public Interest) is devoted to the myriad questions on how our foods do us dirty, because they are intrinsically foul for the system (e.g. liquor) or because they're diluted with gosh knows what kind of additives.  The trouble with sites like this is that they prove everything is bad.  The virtue is that they can teach us a few changes in lifestyle.  See www.cspinet.org.

73. Best Hospitals 2001
Don't you believe it.  We have been in a couple of these joints, and they're not your road to survival.  What this establishes is that these hospitals have some good specialists -- not that they have good care, necessarily.  Remember that you can consult a specialist without putting yourself at the mercy of a hospital.  This list symbolizes our health dilemma.  We pay too much attention to the craft expertise of our doctors, not enough to patient care.

72. Learning How to Fight the Bio-Threats
Courses on a University of Alabama website that teach you how to diagnose anthrax, smallpox, etc. in the early stages.  See www.bioterrorism.uab.edu.

71. Rick Mendosa's Diabetes Directory
See www.mendosa.com/diabetes.htm.  Both Mr. Mendosa and his wife are diabetics.  And he has aspired to be the world's best writer about diabetes.  (See entry #67 below.)  He fits our definition of a good care-giver: you must be afflicted yourself to understand the problem.  "This is a directory of diabetes-related Web pages on this site and other Web pages written by me at the Web sites of the American Diabetes Association and elsewhere."

70. Paperless and Errors -- Less So
GE Medicare Systems is pushing to digitize hospitals to cut costs and errors.  GE Centricity ostensibly chops away at errors that "are estimated to kill up to 98,000 people a year...."  See Business Week, February 18, 2002, p. 93.

69. Drink Red
The scientists have been telling us for years how the French eat rich food, drink a lot of red wine, and still have less coronary trouble than Americans.  Not just any red wine, though: cabernets work better.  The theory has been that red wine reduces oxidants, but Dr. Roger Corder at London's William Harvey Research Institute thinks the key is that the reds fight endothelin 1, a constrictor of blood vessels.  See The New York Times, December 21, 2001, p. A17.  Nobody is sure why this all works, but we are indeed drinking up.  And we like reds better anyway.

Update: A Belly Full of Wine
For quite a while now, bibblers have rejoiced in the knowledge that their consumption of red wine has something to do with avoiding heart attacks.  Of course, the Japanese drink very little red and suffer less attacks than many in the West.  The news is that scientists are beginning to understand how the reds work their magic---in the stomach, not in the bloodstream.  “If the two mix in the stomach, compounds in the wine thwart the formation of harmful chemicals that are released when meat is digested.”  (See The Economist, July 5, 2008, p. 88).  Dr. Kanner of the Hebrew University of Jerusalem “hypothesized that if the polyphenols arrive in the stomach at the moment when the fats are releasing malondialdehyde and its kin, then this might stop these toxic materials from getting any farther into the body.”  In experiments he finds that the wine does act on the malondialdehyde and also hydroperoxides, “another group of oxidising agents that cause cell damage.”  (10/22/08)

68. Medicine's 10 Greatest
Who knows whether the list is right, but it's a chance to learn about some people we did not know.  You can either read Meyer Friedman's and Gerald Friedland's book, Medicine's 10 Greatest Discoveries, or you can get a rundown at Medicine's 10 Greatest Hits: Curiosity's Reward.  The list:

a. 1543 - Vesalius' detailing of human anatomy.
b. 1628 - William Harvey on heart circulation.
c. 1675 - Anton Leeuwenhoek discovers bacteria.
d. 1796 - Edward Jenner uses cowpox to protect against smallpox, and also uses other dead toxins to protect against other diseases.
e. 1842 - Crawford Long develops surgical anesthesia.
f. 1895 - Roentgen and x-rays.
g. 1907 - Ross Harrison grows living cells outside the body.
h. 1912 - Nikolai Anichkov discovers cholesterol is the basis of coronary artery disease.
i. 1928 - Alexander Flemming and penicillin.
j. 1950-53 - Maurice Wilkins isolates single fiber of DNA, leading to work of Watson and Crick who develop a double helix model.

Most of the great work, and most of the great medicine, does not come from drug discoveries but from a better understanding of how the body works.  This tells us where medical research monies should be directed.

67. More Than You Ever Needed to Know About Sawtooth Palmetto
Rick Mendosa has done everything hip and complex, and aspires to be the world's best medical writer about diabetes.  He is a good writer and he clearly has done the definitive article about sawtooth palmetto.  (See www.mendosa.com/sawpalm.htm.)  As one of my graduate students opines, "It's for bad pipes," which is also known as benign prostatic hyperplasia (BPH), a condition that often affects men in their 50s, when various swellings make for both difficult and frequent urination.  (If you're a literary sort, read about Paul in John O'Hara's A Rage to Live.)  Now the doctors push surgery or drugs for this condition because that's what doctors do.  To his credit, our own internist suggested sawtooth palmetto, though he could not remember the best recipe which comes out of Germany, apparently.  The source of the new material for all the world, incidentally, is Florida, with Germany, Switzerland, and Italy being the best formularies.  Bottom line: It's sold at Costco, but you may want to look for finer grades.  And the best worldwide standards for alternative treatments, including sawtooth, seem to obtain in Germany, so that's probably where the best alternative, quality drugs come from.

66. Cutting Diabetes
Weight is the story.  A Massachusetts General study headed by Dr. David M. Nathan, done for the federal government, revealed "that even modest changes in living habits -- eating less fat, exercising two and one-half hours a week and losing an average of 7 percent of body weight -- cut the incidence of diabetes by more than half over a three-year period."  Several oldsters know this is true, but just can't get the deed done.  Once again, prevention is cheaper and better than drug treatment or other alternatives.  See the New York Times, January 15, 2002, p. D7.

65. Drugged to Death
"The 106,000 deaths from drug reactions tabulated by The Journal of the American Medical Assn. for 1998 makes medication side-effects the fourth leading cause of death in the U.S."  See O'Dwyer's PR Services Report, January 2002, p. 18 (www.odwyerpr.com).  Another big killer -- from the halls of medicine -- is hospitalization itself, where we lose an extraordinary number of people.

64. Spend It Your Way
"Under a defined-contribution plan, each employee gets a set medical budget--say $2,000 a year--which can be spent on virtually any health service."  After that, the patient pays everything--up to a certain level, when the employee kicks in again.  The thought is that this will contain costs yet create employee satisfaction, allowing each worker to run things his or her own way.  Textron (NYSE:TXT, www.textron.com) and Medtronic (NYSE:MDT, www.medtronic.com) are companies that are experimenting with such plans; Definity Health Corporation is one company selling such plans to others.  See the Wall Street Journal, January 8, 2002, B1 and B4.

63. Cigarette Warnings Help
A Canadian Cancer Society Study "has found that larger, more graphic health warnings on cigarette packs have heightened concern about the dangers of tobacco...."  Brazil and European Union countries are also moving toward larger warnings.  See The Wall Street Journal, January 10, 2002, p. B6.  It is unclear is more people quit because of such warnings, however.

62. Absolute Puritanism
Theodore Dalyrymple (a.k.a. Anthony Daniels) is a British physician and psychiatrist who is willing to take on the health police.  In this instance, the American Medical Association, gone awry, has gotten mad about late-night liquor advertisements on T.V.  "In my own code, it required no advertisements to persuade me to drink alcohol every day."  "But health is not the only good, much less the supreme good, of human existence.  Indeed, excellent health is neither sufficient nor necessary for the good life, and he is not always happiest who lives longest."  See the Wall Street Journal, December 21, 2001, p. A14.  Also, see Dalrymple's several books, including:

Mass Listeria: The Meaning of Health Scares
So Little Done: The Testament of a Serial Killer
Life at the Bottom: The Worldview that Makes the Underclass

61. Healthful Jogging
We all know jogging nuts who drop dead from their addiction.  Now we can include one of the pioneers, Jim Fixx.  Tara Parker-Pope, a practical health columnist, tells us to combine walking and running for better running, especially if you're out of shape, but perhaps in any event.  Olympic runner Jeff Galloway has a website (www.jeffgalloway.com) dedicated to the subject.  A fatty John Bingham tells us how well this has worked for him at www.waddle-on.com.  See the Wall Street Journal, December 21, 2001, p. B1.

60. Watch Out for Boiling Water
A good friend writes that you can scorch yourself badly boiling water in the microwave, as the note below explains:

"My 26-year old son decided to have a cup of coffee. He took a cup of water and put it in the microwave to heat it up (something that he had done numerous times before).

I am not sure how long he set the timer for, but he told me he wanted to bring the water to a boil. When the timer shut the oven off, he removed the cup from the oven.

As he looked into the cup, he noted that the water was not boiling, but instantly the water in the cup 'blew up' into his face. The cup remained intact until he threw it out of his hand but all the water had flown out into his face due to the build up of energy. His whole face is blistered and he has 1st and 2nd degree burns to his face which may leave scarring. He also may have lost partial sight in his left eye.

While at the hospital, the doctor who was attending to him stated that this is a fairly common occurrence and water alone should never be heated in a microwave oven. If water is heated in this manner, something should be placed in the cup to diffuse the energy such as a wooden stir stick, tea bag, etc. It is however a much safer choice to boil the water in a kettle.

General Electric’s response:
'... Microwaved water and other liquids do not always bubble when they reach the boiling point. They can actually get superheated and not bubble at all. The superheated liquid will bubble up out of the cup when it is moved or when something like a spoon or tea bag is put into it. To prevent this from happening and causing injury, do not heat any liquid for more than two minutes per cup.

After heating, let the cup stand in the microwave for thirty seconds before moving it or adding anything into it. I hope this helps.'"

59. Religion and Health
The part religion plays in health has long been debated.  In some faiths, such as Christian Science, belief mandates health practices that are felt to sustain body and soul.  John Templeton, one of this century's great money managers, has endowed studies of the relationship of religion and science and feels that religion and health are linked.  Some surveys argue that there is a close affinity between a belief and good health.  (See "Religion Can Be Good Medicine, Study Finds," HealthScoutNews, October 2, 2001.)

58. A Good Friend's Healthy Advice
We received this prescription from a good friend:

“A world class medical researcher told me that there are basically two things one can do to improve one’s health. Stop smoking and get a colonoscopy. The reason for the latter is not that it is a better diagnostic tool than a number of other procedures but that, should something be found, something important can be done about it. I’ve experienced this in my own life; the procedure may well have saved me, and I go back every five years.”

We would add a third: Have a purpose that you pursue with relentless cheer.  Happy warriors often live longer.

57. Eureka, Oregano
Oregano-oil has proven effective against fungi and bacteria in some animal experiments.   And a test-tube trial shows promise against anthrax.  Somewhere along the line, we will do a better job of tapping into nature to keep disease at bay.  See Business Week, October 22, 2001, p. 66.

56. Eye Tests
One of our correspondents supplies the following sites for those wanting to check out their vision.  In many ways, they're a curiosity, of course, since you will have to see an eye doctor anyway, especially if you are over 40.


55. Colon-Watching
Colon cancer is the second biggest killer in the U.S.  But only a third or so of people over 50 have colonoscopies, which, done with regularity, can virtually prevent the onset of the disease.  Now complex but much less onerous cat or ct-scans are being used experimentally to find cancers and polyps.  They may turn out to cost about half what colonoscopies do, which are expensive in-hospital procedures.  See Business Week, October 15, 2001, p. 129.

54. State of Health
This is just a beginning, but it will help.  The Kaiser Family Foundation now offers "State Health Facts Online" at www.statehealthfacts.kff.org.  All disease is local -- and it must be managed locally.  With better state and local data, preventive health programs could really go somewhere.  Right now accurate data is not regularly released to media in each locality, and remedial behaviors are not dessimated in targeted areas.

53. My Turf
At www.formyworld.com you will uncover, for your zip code, local pollution data, gardening tips, and other aspects of nature in your home town.

52. Healthy Hearts
Tara Marker-Pope of The Wall Street Journal has written the first short, intelligent article we have seen anywhere on what to watch out for when you're looking for heart disease.  Keen data watchers have long known that cholesterol is a mixed indicator in trying to predict whether you're in trouble or not.  Watch it but don't treat it as gospel, because there are a host of things that bear watching--and even then you have to be cautious in how to act on a blip.  Among other things, the article focuses a bit on homocysteine, something we think bears particular attention.  See "New Tests Go Beyond Cholesterol to Find Heart-Disease Risks," The Wall Street Journal, June 22, 2001, B1.

51. Short Cuts
See www.yoursurgery.com.  More than fifty surgical procedures are detailed here with pictures.  So you can tell what you're getting into if you have a colactomy or decide to replace a heart valve.  Still, the usual caveats apply: don't expect this site to make you aware of all the risks.

50. Headache Central
At www.achenet.org, you will find a stream of research and links about headaches.  Some sufferers have claim to have found information--not available at the their HMOs--that has provided relief when every other avenue has failed..

49. Diet Sites Are Heavyweights
Traditionally, everybody loses money in the web content business except  the pornographers and the financial data (stock information) peddlers.  But now, with sites such as ediets.com and cyberdiet.com posting significant profits, it looks like diet websites will also make a nickel.   This is highly encouraging, since a host of epidemic health problems (such as diabetes) relate to the horrific diets and expanding waistlines of Americans.  Sites like these can make dieting and exercise interactive and compulsive. Perhaps we are on our way to a national preventive health program.  See Bob Tedeschi's "E-Commerce Report," New York Times, April 30, 2001, p. C8.

48. Some of Kindlmann's Favorite Health Sites
A reflective engineer at Yale, he mentioned a few sites he liked in December 1996. We've chosen two that bear watching:  The Merck Manual of Diagnosis and Therapy at www.merckhomeedition.com/home.html and The New England Journal of Medicine On-Line at www.nejm.org

47. Fat Stuff
For those who want to worry about themselves and others, try this site on obesity, www.whyfiles.org/067fat.  It tells you how we are getting fatter and fatter, etc.

46. British Medical Journal--Free
It's available free of charge on the Web, so it's having a deep impact even in the poorest countries around the globe.  The medical journals have the same ethical problem as the drug companies--how to put knowledge and cures in the hands of people who can't pay the tariffs.  Necessarily, government public health bodies will have to play a part in such dissemination in the years ahead.

45. Why Are We Waisted?
Virginia Postrel offers up another incisive column for The New York Times ("Economic Sense," March 22, 2001, p. C2).  In it, she gets at some root economic causes of why we are fat and unhealthy.  She refers to an article by Thomas J. Philipson and our old friend Richard Posner--"The Long-Run Growth in Obesity as a Function of Technological Change."  Writ large, they seem to be saying we are getting faster because the 20th century's vast agricultural advances have made calories cheaper.  Meanwhile, people no longer get paid for physical exertion at work, but, in fact, earn their living in this digital age sitting down.   So we are eating even higher off the hog, but we ain't carrying hod anymore.  And that's how we got waisted.

Years ago Richard Hofstrader called John Calhoun of South Carolina the Marx of the Master Class.  With affection, we must term Posner, who has written about prostitution as well as Bill Clinton's dalliances, the Marxmaster of Affluence and the Seven Deadly Sins.

44. Too Much Iron
In "Iron Overload," Carol Gentry says that many of the complaints of old age may stem from too much iron in our system.  (See The Wall Street Journal, "Encore," March 19, 2001, p. R4.)  The disease hemochromatosis "affects more than one million Americans...."  It's simple to test for, but left untreated it can lead to a host of serious conditions.   This could be the cause of your chronic fatigue, stomach aches, joint pain, heart palpitations, impotence, or depression.

43. Hardin Meta Directory of Internet Health Sources
See www.lib.uiowa.edu/hardin/md/index.html.   We can't vouch for the quality of the sources, but at least this site is put together by folks in the medical trade who are trying to do the right thing.  The Internet--as you know--has it all, good and bad.

42. Avoiding the Sweet Stuff
The plant stevia is being embraced by many as a better substitute for sugar than aspartame or saccharin.  Apparently the F.D.A. has no test data on its efficacy or safety, so it has to be sold as a diet supplement.  See "So Sweet, So Natural, So L.A.," New York Times, March 7, 2001, p. B12.  Seed sources cited are Thompson and Morgan (1-800-275-7333), Johnny's Selected Seeds (www.johnnyseeds.com), and Tea Herb Farm (www.serve.com/teaherbfarm); plants can be had at Logee's freehouses (www.logees.com) and Mulberry Creek Herb Farm (www.mulberrycreek.com).

41. Medline Plus
The Wall Street Journal's Laura Landro has written cogently and frequently about the Federal government's ongoing effort to bring good health informtation to healthcare professionals and consumers.  One surprise, in fact, is that laymen look at the professional literature as often as the experts, perhaps because they have a vested interested (i.e. their own health).  At any rate, the Medline Plus consumer page is a great place to start exploring the treasure trove available through the National Institutes of Health; after that, you can go deeper if you choose.

40. Rolling Rocks Uphill
Obviously one has to be obsessive to roll rocks uphill.  Ask the Australian doctor who uncovered the bacterial foundation and cure for ulcers.  Or ask the Boston researcher who thought folic acid might have something to do with arresting heart disease at a time when cholesterol was the sole research theme in Boston and Framingham: he was exiled to a VA hospital. 

Likewise, serious researchers in cancer have to take on the world.  A recent book by Robert Cooke, Dr. Folkman's War, details the unseemly way the medical establishment resisted the concept of angio-genesis, which roughly means starving cancer cells to death by cutting off their blood supply.

The New Yorker (February 5, 2001) recounts how Nicholas Gonzalez has been sent to professional Siberia for advancing very unconventional cancer therapy based on nutrition and enzyme treatment.   See "The Outlaw Doctor," by Michael Specter, pp. 48-64.  Gonzalez took up the alternative theories of William Donald Kelley, an orthodontist from Grapevine, Texas. 

The revived New Yorker is making a very big dent in the whole question of getting the medical field to look at its doctrines more carefully.

39. Making Up Your Own Mind
A gripping account, Alice Stewart Trillin's "Betting Your Life" tells how she had to figure out what to do when her doctors disagreed.  See The New Yorker, January, 2001, pp. 38-42.   The initial signs pointed toward a recurrence of cancer 14 years after the first episode.  It turned out to be a false alarm, but she only worked overcame the worry by patiently visiting with a slew of "experts."  This is not unusual; it only points out once again the need for a process, based on good data, by which patients with life-and-death symptoms can negotiate their own fates.

38. Recess for Teachers
We have long remarked here that schools run amok are stuffing kids with an unfocused curriculum, too many class periods, too much to do after school, too much homework, not enough joy, and very low-order learning.  Life, though, is just as bad for teachers.   However dedicated, teachers are under-focused and terribly overworked.  When the system is running ragged, it takes everybody down.  In North Carolina, there's some recognition of this problem: the nation's only teacher burnout center.  Located in Cullowhee, NC, the retreat is bureaucratically known as the North Carolina Center for the Advancement of Teaching.   See "Giving the Teacher Balm for Burnout," New Times Education Life, January 7, 2001, pp. 24-27.  It was founded in 1985 by former Governor James Hunt, who has tried to get a grip on North Carolina's K-through-12 educational problems.

37. Stresstistics
The literature of stress is beginning to soar as high as stress levels.  Most recently, The Wall Street Journal is now covering the front page of its Marketplace section with tales of the burnt out and burnt up.  (See January 16 and 17, 2001 editions.)  On the 16th every article was about stress, including "Impossible Expectations and Unfulfilling Work Stress Managers, Too," "Can Workplace Stress Get Worse?," "Incidents of 'Desk Rage' Disrupt American Offices," "At Verizon Call Centers, Stress Is Seldom on Hold," and "Mergers Often Trigger Anxiety, Lower Morale."  Will all this commentary begin to solve our biggest health problem--burnt-out people of all ages, all demographics?  We suspect so.   In New Hampshire a few weeks back, we were chatting with a renowned medical researcher who's aware of the problem and traces it to our digital culture.   Everybody's noticed that there's just too much electricity in the air.

36. Safe Helmets
Despite all the kids on scooters, bicycles and the like, not all helmets really protect the wearer.  Canada has a very good standard, CAN/CSA-D113.2, authored by the Canadian Standards Association.  Basically, this standard ensures that the helmets can take a really big shock and that they will stay firmly on the head without strangling their users.  According to our information, Bell Sports, Troxel, Specialized, and some others in the U.S. have helmets that are certified against this standard.  So look for the CSA sticker.

35. Paris Pacifiers
Since the Paris subway system is a mess, it is now offering passengers at some stops a free massage and a healthy snack,  And it is sprinkling "Smile" and "Serenity" posters here and there.  Well at least it's not trying to reform things.  See The Globe and Mail (Canada), January 9, 2001, P. A11.

34. Arthritis and Pain Disorders Information
If you are hurting, click here for some associations that may help.  We stole this list (compiled by Wendy Huntington) from an ad supplement called "From Cause to Cure" found in The New York Times Magazine, December 10, 2000, p. 98.  Feel better.

33. Stress Your Way to Bad Health
A recent study shows that stress-filled senior citizens get less protection from pneumonia shots than their placid peers.  This is just one of many little bits of evidence that stress, a central byproduct of  our digital society of email, cellphones, and palm pilots, is over-taxing kids ranging from 5 to 90.  See "When Stress Erodes Vaccine Benefits,"  The New York Times, December 12, 2000, p. D8.  How about the 1,000,000-plus emails Vice President Gore sent out during the last 30 days?

32. Pioneers in the North Country Fair
On several fronts, the state of New Hampshire has led the nation in the shared decision-making arena, whereby patients get the best data on critical diseases in order to guide their own therapeutic treatments.  But it is also out in front on other important initiatives.  "Asking for Directions,"  initiated by researcher Chuck Rhoades, strives to get men talking about their health problems, with the hope that they may get to a doctor sooner in order to do something about an illness when it counts.  Men have a  history of ignoring bad signs of trouble until it is too late.   See "Experiment Aims to Get Real Men to Go to the Doctor,"  The New York Times, December 12, 2000, p. D6.

31. Beware of Saviors
In an interesting new book on shellshock and the like, Ben Shepherd says we do a lot of wrong  in trying to bring soldiers back from traumatic breakdown.  In A War of Nerves:  Soldiers and Psychiatrists l914-1994, he even seems to say that "the counseling industry often perpetuates trauma-induced illnesses."  As reviewed in The Economist, December 2, 2000. p. 85.

30. Attention Deficit Versus Karate
Some commentators have long known that school environments are anti-child, particularly anti-boy.  We make kids sit in tight quarters for ungodly periods of time and then we wonder why we have lots of itchy, yet apathetic, distracted children who need ritalin, or other problem drugs we do not understand, to try to stay the course.  Proper exercise and breaks would remedy lots of problems.  Now, at last, some are finding that cerebral martial arts help kids get focused.  See "Using Martial Arts for Attention Disorders," New York Times, December 2, 2000, p.A16.

29. Promising Allergy Tests
Immunocap, from Pharmacia Group, seems to be proving an effective, low-pain test for allergies.  A couple of articles in The Journal of Allergy and Clinical Immunology underline the efficacy of blood testing as well as the improved results arising in the use of Pharmacia's test.  While if you have a child with allergies this may be a good route for you, you will have to push this alternative since the medical community is rather wedded to older testing methods.  See Tara Parker-Pope, "A Simple Blood Test Could Clear the Air for Allergy Diagnosis,"  Wall Street Journal, September 15, 2000, B1.

28. Decline of Public Health
Catherine Arnst's  excellent review of Laurie Garrett's Betrayal of Trust: The Collapse of Global Public Health nicely sums up the key messages of this rather exhaustive book (Business Week, October 2, 2000, pp. 29-31).   Worldwide, the public health system is in shambles.  In the U.S., it is simply a disgrace, resulting in mortality figures that are no better than nations with much poorer economies.  Garrett notes that less than 4% of the total improvement in life expectancy since the 1700s can be attributed to 20th century advances in medicine.   Public health measures account for 96% of the improvement, but we're focusing on the 4%.  The economic costs of this folly are increasing.

27. Washing Your Hands
When I was a youngster, one of the ways we thought we would avoid getting polio was to wash our hands after going to the bathroom.  Well, polio is practically gone,   and only a few compulsive types like myself are still washing their hands.   See “Our Dirty Little Secret,”  Anita Manning, USA Today, September l8, 2000.  “More than 95% of people surveyed say they always wash their hands after using public facilities.  But researchers who lurked in bathrooms found the ugly truth:  only 67% actually do.” One Dallas acquaintance always uses a paper towel to open the door when he exits a restroom, since he knows bacteria are swarming around the door handle.  Even if that is a bit much, he has a point, since public bathrooms do seem to get a little dirtier as the years go by.

26. The Geography of Surgery
See articles on September l8 and l9 in USA Today by Dan Vergano.   Mr. Vergano taps into the Dartmouth Atlas, the creation of Dr. John Wennberg at the Center for Evaluative Clinical Sciences in Hanover, New Hampshire.  Basically it finds that you may get a mastectomy, or prostrate removal, or angioplasty more often in some parts of the country than others—not because it will necessarily do anything for you but because there is someone around to do the cutting.  In other words, we find an awful lot of evidence that you may die from too much treatment or, alternately, from too much hospitalization.  Conclusion:  get yourself on a level playing field if you have a severe medical problem, by securing top clinical data and learning all your options.  See USA Today, September l8 and l9; use search terms Dartmouth Atlas, or Wennberg, or Geography of Surgery.

25. Just Say No.
Nancy Reagan told us to say no to drugs.  Alas, as significant, especially for our children, but for ourselves as well, is to say no to all the frenzied activities that have crowded out civility and spirituality.  To this end, take a peek at the weekend Wall Street Journal, August 25, 2000, “Kids Call for a Time   Out,” by June Fletcher, pp. Wl and W16.  A "growing number of parents think the hyperscheduling of kinds has gone too far.  They are yanking their children out of activities that rob them of time to study, eat family dinners and simply dawdle.”   The article is particularly good at describing the amount of time that is consumed by athletics, music lessons, etc. in order for children to achieve high proficiency—as if that really should be anyone’s goal.

Just as draining, however, for kids is the school day itself which is insanely overscheduled.  Often there are no breaks during the day, with a short lunch to boot.  More than 50 years ago, back in ancient time, we learned from studies about telephone operators that people simply are not productive without breaks.   Somebody has failed to communicate this to the policy people in the school networks,  from administrators to state education officials.  We are doing more stuff in our schools, but we are not doing better.

24. Okay Health Sites
The only thing that outweighs the health content on the Internet, apparently, is pornography.  And publications plus medical societies have warned us that 90% of the health sites are either useless or downright harmful.  Bottom Line (August 1, 2000) includes a few that are at least respectable.  More  importantly, you can depend on them to lead you to authoritative places.  It lists:

Asthma: American Academy of Allergy, Asthma, & Immunology www.aaaai.org

Arthritis: Arthritis Foundation

Breast Cancer: Oncolink: Breast Cancer

Cancer: American Cancer Society

Depression: Depression.com Homepage

Diabetes: American Diabetes Association

Heart Disease: Heart Information Network

Prostate Cancer: Mediconsult

23. Reprise on Cholesterol
I have met more than one terribly talented doctor who finds the fascination with cholesterol to be much overdone.  Some of us have observed that research into the effects of folic acid suggest that cholesterol levels may be symptomatic, not causal, of heart problems.  Nonetheless, those who are enamoured of the Framingham heart studies have now lowered the benchmark for acceptable cholesterol well below 200.

One of our Chapel Hill correspondents takes a different cut on the problem.  He allows that lowering cholesterol may promote lower cardiac risk, while raising all other disease perils.  That's the trouble with heart studies: they just look at the heart.  Periscope research sees the threat just ahead, and misses the dive bombers just over the horizon.  Similarly, U.S. research on the health effects of microwaves (as opposed to that done in Russia) has only looked at limited frequencies, probably missing microwaves' deep, long-term threat.

Our reader has looked at the "longest time period cholesterol study" that he knew of--work done in Norway.  "The Norwegians ... tabulated all causes of mortality.  Those who reduced their cholesterol had higher mortality in every category except cardiac than the control group...."

By the way, brain cell membranes depend on high cholesterol for their fluidity, according to our correspondent.  I suppose too little cholesterol leads to dry brain.

Don't give up your cholesterol-lowering program.  But do it with some humor, because the doctors will be changing their tune eventually.   As Horatio says, "Moderation in all things," and that probably includes moderation itself.

22. Hamstring Yoga
Because of the million fiefdoms in Yoga and the uneven literature reviewing their doings, we are always hard put to say what Yoga's contribution is or could be to those who want to be healthy.  We know, intuitively, that it could be massive.  In the aftermath of a recent conference in Lennox, Massachusetts called "The New American Yoga," we are glad to learn its divisions, at least in the U.S., are being smoothed over.  Soon, we will better understand its values, even if so many of its practitioners always look unhealthy.  See Ann Powers, "American Influences Help Redefine Practice of Yoga," New York Times, August 1, 2000, D7.   "As the medical establishment continues to accept the mind-body connection, the more room American yogis are finding to develop their plain view of the divine within the hamstring."

21. Ear Infections: Cheap Fix
All of us know that young kids get lots of ear infections and that our antibiotics are increasingly ineffective.  "Xylitol," derived from birch trees, has demonstrated great efficacy against otitis media.  It is preventive in nature, outgunning vaccines and lasers and other expensive fixes posed by the drug companies.  See "Sugarless Gum May Help to Prevent Ear Infections in Kids," Wall Street Journal, June 20, 2000, p. B1.

20. Easy Does It
Well, up to now, Nike had us on our mettle, saying, "Just Do It."   But that was yesterday.  Now, we realize that we should not be doing, even if we are young and energetic.  Teens and young adults are learning that it is time to slow down.  See "Walk on the Quiet Side," The Boston Globe, July 7, 2000, pp. B1 and B5.  The Insight Meditation Society, apparently, is one of the few places in the country to offer a meditation program for teens.

19. Attention Deficit, Hyperactivity, etc.
A close reading of the literature of child-learning problems reveals that we don't know much about all the neuro-glitches that trouble a mass of kids in schools across the land.  Given our ignorance, we are putting awesome amounts of ritalin and other troublesome medications down their throats.  As one physician put it to me, the real problems with these drugs is if they work.  Then you have the quandary of weaning kids off the stuff at some point.  We are discovering that social environmental stimuli (i.e. hyper-environmentals at school, home, and the community) play a profound role in these conditions, whatever is amiss in a child's wiring.  For a collection of current thinking, see Thomas E. Brown, Attention-Deficit Disorders and Cormorbidities in Children, Adolescents, and Adults (American Psychiatric Press, 2000).  Dr. Brown is at Yale's Clinic for Attention and Related Disorders.

18. Bach Is Beatific
Now it can be told.  A Bach concerto will calm your brain and tune out the world around you better than most of the tricks that we use to get away from it all.   The Research Imaging Center in San Antonio looked at the brains of piano players playing Bach concertos and found that the concentration necessary to play the music put much of the brain in a deep freeze in order for the relevant parts to better focus.   See Across the Board, June 2000, p. 72.

17. Missing the Big One
It's funny now to see "homocysteine" become respectable.  Even mainstream researchers now admit it is as important as cholesterol in causing heart disease.  See Jane E. Brody, "Health Sleuths Assess Homocysteine as Culprit," New York Times, June 13, 2000, D1 and D6.  Dr. Kilmer S. Mckully discovered this substance while at the Harvard Medical School in 1969, but since cholesterol was the theory of the day the powers-that-were had no time for his thesis.   They drove him out of town--to Providence, Rhode Island.  Some even feel that homocysteine may be much more causal than cholesterol in heart disease.  This is just like the "ulcer story."  Remember when ulcers were caused by stress and bad foods, until an Australian uncovered the bacteria that account for 90% of the cases?   Moral: Keep an open mind, since the accepted wisdom is often devastatingly wrong.

16. Recommending Groopman
Jerome Groopman, a Boston doctor, is required reading for anyone who wants to intelligently manage his or her health.  On subjects as widely varying as "The Doubting Disease"--obsessive-compulsive disorder--and "The Prostate Paradox"--prostate cancer--he sets out all the doubts intelligent people should have about diagnosis and particularly treatment of these serious diseases.  See The New Yorker, May 24, 2000, pp. 52 ff and The New Yorker, April 10, 2000, pp. 52 ff.  In each instance, there are serious questions as to what to do as well as downsides that committed specialists many not communicate to the afflicted.

15. Prostates In; Prostates Out
For some reason, prostate cancer is an "in" disease at the moment, and we ourselves know of more studies, websites, and more panaceas that are about to burst on the scene.  Groopman, mentioned above, provides the best picture of what goes on with each kind of treatment, including the several limitations of surgery and radiation.  Lawrence Altman, "Exploring the Enigma of Prostate Therapies," The New York Times, May 9, 2000, D8, amply and succinctly shows that we lack good data on the outcome and side effects of several treatments.  If you are going to use a therapy--and it's not always clear that you should--early detection is the key, as with all cancers.  We are making good progress there with souped-up PSA tests, as well as genetic testing.  See Business Week, May 1, 2000, pp. 128 and 130: We have to pay attention, because, by age eighty, nearly fifty percent of men have some form of prostate cancer.

14. Dead Air
We have previously commented on how buidlings of all sorts increasingly harbor bad air, molds, bacteria, etc.  If you travel, you are certainly aware of the same problem in air travel.  A recent Wall Street Journal article, "How Safe is Air-plane Air," June 9, 2000, W1 and W16, reveals that you are breathing very stale air aboard almost any flight you choose in the continental United States.   There's not much to be done, but get up and move about fairly often.  If the plane stops along the way, always get off for a breather.

13. Sick Buildings
In the 1950s, you had to worry if you were a minority baby living in a tenement in New York, since you might end up eating chipping paint that was laced with arsenic.  Now, in 2000, you must be concerned about your office and your home.  And the more up-to-date your structure is, the more likely it is to have some environmental flaws.  See "Is Your Office Killing You?" by Michelle Conlin, Business Week, June 5, 2000, pp. 114-130.  While this article is far from comprehensive, it does point you in the right direction.  At home or at the office, look hard at your venting systems, since in many places you are only recirculating the same bad air--a common complaint, too, in airplanes.  Open windows frequently, if your windows open at all.   Not only use experts to test for problems, but find someone who has strong allergies to find out if you're living in a viper's nest.

12. Health on the Net Foundation
A not-for-profit foundation, it is headquartered in Geneva, Switzerland.  It tries to integrate legitimate information from the Internet and its code of conduct project is an attempt to improve the quality of healthcare information on the Web.  Since bad sites and faulty information have proliferated on the Internet, the quest for Internet standards has itself become a preventive health issue.   See www.hon.ch/home.html.

11. Getting Your Bite Back
A variety of remineralization techniques are coming into play for putting your teeth back in shape (see Tara Parker-Pope's "New Products Aim to Repair Damage of Early Tooth Decay," The Wall Street Journal, April 21, 2000, p. B1).   We ourselves use one such toothpaste not listed in the article.  Everything -- from Trident gum to mouthwashes to toothpaste -- is being used to put the minerals back in teeth, fighting early cavities. Nobody seems to know what works best.

10. In Praise of Mother's Milk
One of our correspondents from North Carolina sent in an interesting postscript on our asthma discussion.  He suggests that the national decline in breast feeding directly correlates with the rise in asthma.  "Apparently mother's milk was designed to provide antidotes to some allergenic risks...."  The advent of working mothers and the predisposition of hospital personnel towards milk substitutes has accelerated the substitution of formula for mothers' bounty.  Incidentally, there have been some studies which support our reader's hypothesis.  In any event, we seem to pay a tremendous price when our fashions and habits get at loggerheads with the ways of nature.

9. Dealing with the Asthma Epidemic
"In the United States 15 million people have asthma, five to six million of them children -- more than double the number in 1980."  (See Ellen Ruppel Shell, "Does Civilization Cause Asthma?" The Atlantic Monthly, May 2000, pp. 90-100).  Nobody knows why.  Some theorists, however, believe that "modern hygiene practices and antibiotics...foreclose the need for the young immune systems to tackle microbial and parasitic challenges."  "By legitimately protecting our kids from dangerous infections we may have kept parts of their immune systems from maturing."  Too frequent use of antibiotics in general and too little exposure to certain of the natural grime of life may cause immune systems to go awry.  If asthma is, oddly enough, a disease caused by too much medicine and too much industrial civilization, both medical restraint and parental common sense may help prevent asthma more than active public health measures.

8. Andrew Weil
There's broad enthusiasm now about Dr. Weil, who once operated at the margins, but he's now reached the stage of being interviewed by Larry King.  He combines traditional medicine and alternative medicine, with particular emphasis on eating right.   Check out Ask Dr. Weil online.   Two of his current books are:

Eating Well for Optimal Health: The Essential Guide to Food, Diet, and Nutrition

Spontaneous Healing: How to Discover and Enhance Your Body's Natural Ability to Maintain and Heal Itself

7.  Retrofitting the Brain
Keep Your Brain Alive, by Lawrence C. Katz and Manning Rubin (Workman, 1999) looks like pop self-help literature, but it is backed up by reasonably serious science.   Exercising the brain seems to keep it alive, stimulating, amongst other things, the same hippocampus that we mention in "Swollen Brains" in Wit and Wisdom. Apparently, the key to brain activity and memory is enhancing connections between elements of the brain, just as computer design people are now enhancing connections between the memory and the other parts of the computer.  Check out the book's website to read more about it.

6. Cancer Vaccines
At long last, biotech labs are making progress in cancer vaccines, especially vaccines that prevent cancer's recurrence.  The base technology has been erected by Boston's Dana Farber Cancer Institute, and it is now being further developed by researchers here and abroad.  See "One Vaccine, Many Targets," Business Week, March 20, 2000, pp. 76 & 78.  

5. Much Earlier Detection Will Nip Diseases in the Bud
Business Week, March 15, 2000, notes several detection technologies that will spot diseases early, helping us deal with problems before they become critical.   Illinois Institute of Technology reserachers almost have prototype breathalyzers to smell your breath and uncover tuberculosis.  Electron-beam computed tomography combined with automated image-reading technology promises to spot dangerous heart conditions early -- before the heart attack.

4. Preventing Preventive Herbal Medicine
The biggest contribution of the medical establishment to herbal medicine seems to be to warn us off the herbs.  Such seems to have been the thrust of a recent confab at Chapel Hill's University of North Carolina, called "The Efficacy and Safety of Medicinal Herbs" (see Denise Grady's article in The New York Times, March 7, 2000, pp.D1 & D4). Of course, the article wryly notes that the medicinal herb industry flourishes in spite of the FDA, the medical community, etc.  Like Linux, Harry Potter, and the massive cult religions infiltrating China, herbalism refuses to be contained. 

Sorrowfully, the practice of botanical medicine in this country has not advanced very far, mainly because no one has figured out how to make big enough bucks off of natural remedies, many of which work more miracles than those ginned up in the labs of the world's pillpushers.

For those who want to probe this subject, we have always recommended Dr. Jim Duke, a retired Department of Agriculture scientist who got all this going on government time.  As you have witnessed time and time again, some of our best innovations come from one outpost of government, only to be smothered by another agency that is feeling very territorial.

The prolific Duke has written widely; several books he's authored or contributed to are cited below.  See also his Nature's Herbs website and his Mini-Course in Medical Botany.

Update: Herbs Safer than Drugs?
Jim Duke, who spent his whole career at the Department of Agriculture exploring the medicinal uses of plants, very much keeps his hand in the game, still traveling to the Amazon in search of new specimens, or giving speeches to herbal practitioners on the state of the art.  We have attached here part of one of his recent speeches, which appears in the following proceedings:  Duke, J.A. 2004. A Third Arm for the Third World. pp 41-44 in Proceedings of the 15th Annual AHG Symposium. Waterville Valley Conference Center. Oct. 8-10, 2004. 236 pp.  What we find interesting is not his extensive list of herbals for various complaints, but (a) his observation of the dangers associated with many pharmaceuticals and (b) his proposal that the FDA do side by side testing of herbals for several complaints when it is looking at clinical trials of new drugs.  Incidentally, should you want to look at the database he still maintains, go to
Phytochemical Database at www.ars-grin.gov/duke.

3. Inform
A chatty letter with lots of informal preventive tips from Employers Reinsurance Corporation, a GE subsidiary (see www.ercgroup.com).   A recent issue has snippets on the virtues of kickboxing, on how aspirin fights cold sores, and on how leg movement is a big retardant to heart disease.

2. Revolution not Reform
The only presidential candidate now thinking in big terms about healthcare is Bill Bradley, and he's not thinking big enough.  The biggest argument the Republicans would have, if they cared, for proving Washington has it completely wrong is the very solid data appearing in The Dartmouth Atlas of Healthcare.  See, for instance, The Quality of Medical Care in the United States: A Report on the Medicare Program: the Dartmouth Atlas of Healthcare 1999.  It, and its predecessors, prove that  healthcare dollars are spent in the wrong places and, particularly, on the wrong things.  All sorts of preventive measures would make a massive difference in the morale and health of Americans.  This volume, and companion pieces, form the intellectual basis for (a) strident efforts in the preventive health area, (b) re-allocation of healthcare resources before we pour more money down this black hole, and (c) institution of informed shared decision-making, giving patients much more intelligent control over their healthcare process.  The ultimate cure for an injured democracy, in any sector, turns out to be more democracy based on a learned citizenry.   See The Dartmouth Atlas of Health Care 1999.

1.  Getting the Right Stuff
One thing we can do ourselves to stay healthy is to stay out of hospitals.   In fact, there is ample evidence that we often kill off healthy people in hospitals, because of hospital germs, bad treatment, or other causes.  We remember being administered the same IV treatment twice at the same time in a top New York city hospital circa 1980.  It's worth checking to see if your favorite hospital has computer safety checks to cut prescription errors.  This healthy practice is increasing (See The New York Times, February 3, 2000, p. C26), and it dramatically cuts prescription errors.

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