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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).
163. -new-
Arsenic
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
http://
ehp.niehs.nih.gov/docs/2005/113-6/toc.html. 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)
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)
158. My First Year of Cancer
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)
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
=46403. New 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)
151. National 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)
150. Hospitals
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.
146. Spice 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.
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.
134. En 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.
133. Abdominal 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.
122. Meditation
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. Migraines—Nerves,
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.
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.
http://www.preventblindness.org/eye_tests/
http://www.blindness.org/html/swarning/wonlinevt.html
http://www.cactus.org/~kingman/CVDtest.html
http://www.opticalinsider.com/webchart.html
http://www.dada.it/eyeweb/eotto.htm
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
www.arthritis.org
Breast Cancer: Oncolink: Breast Cancer
www.oncolink.upenn.edu/disease/breast
Cancer: American Cancer Society
www.cancer.org
Depression: Depression.com Homepage
www.depression.com
Diabetes: American Diabetes Association
www.diabetes.org
Heart Disease: Heart Information Network
www.heartinfo.com
Prostate Cancer: Mediconsult
www.mediconsult.com/prostate
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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