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
283. -new- Against the Grain
We ourselves have vastly cut the amount of gluten that is in our diet. And we have read the bible of the anti-gluten crowd, which is a rather jumbled affair by David Perlmutter called Grain Brain. Michael Specter has written cogently about glutens and more in The New Yorker, November 3, 2014, pp. 58-67.
"Until about a decade ago, the other ninety-nine per cent of Americans rarely seemed to give gluten much thought. But, led by people like William Davis, a cardiologist whose book "Wheat Belly" created an empire founded on the conviction that gluten is a poison, the protein has become a culinary villain. Davis believes that even "healthy" whole grains are destructive, and he has blamed gluten for everything from arthritis and asthma to multiple sclerosis and schizophrenia. David Perlmutter, a neurologist and the author of another of the gluten-free movement's foundational texts, "Grain Brain: The Surprising Truth About Wheat, Carbs, and Sugar—Your Brain's Silent Killers," goes further still. Gluten sensitivity, he writes, 'represents one of the greatest and most under-recognized health threats to humanity.'"
"Sales of gluten-free products will exceed fifteen billion dollars by 2016, twice the amount of five years earlier."
"The most obvious question is also the most difficult to answer: How could gluten, present in a staple food that has sustained humanity for thousands of years, have suddenly become so threatening? There are many theories but no clear, scientifically satisfying answers."
"Joseph A. Murray, a professor of medicine at the Mayo Clinic and the president of the North American Society for the Study of Celiac Disease, has also studied wheat genetics. He agrees with Kasarda. "The wheat grain is not a lot different than it was fifty years ago,'' Murray told me. "Chemically, the contents just have not changed much. And there is something more important to note. Wheat consumption is going down, not up. I don't think this is a problem that can be linked to the genetics of wheat."
"Later that week, I flew back to New York, went home, and dumped my vital wheat gluten in the trash. I have returned to baking whole-wheat bread the way it is supposed to be made: water, yeast, flour, and salt. I will try to live without the magic wand. But I am certainly not going to live without gluten. That just seems silly."
Our own conclusion is that the evidence about gluten is inconclusive. We simply do not know if it hurts you unless you are a suffer from celiac disease. But we do know that we inhale too many grains every day, and it behooves us to restore balance. It is clear that cutting glutens helps one lose weight, and the whole nation is overweight. In addition, there is good anecdotal evidence that one's tastebuds are more sensitive and discriminating if one does not consume so much refined flour and other altered grains. (4-22-15)
282. Tamar Adler's Health Soup
We don't know whether this should be posted in our health section or our humor section. Jusr like Jewish penicillin, it is hard to take all this very seriously. At any rate, you can find the whole concoction here. This is a recipe for a very big batch, because it freezes well; in addition to death and taxes, we can be confident of future illness. If you want less soup, halve the recipe. If the sick person likes noodles when sick, I add a single serving of rice noodles for each serving, in the last few minutes of warming it.
Featured in: Delicious Medicine for the Body and Soul (2-11-15)
281. Grain Drain: Gluten Free
The New Yorker has an article on the gluten-free craze which is mercifully short and nicely informative. Most of the writing on the subject comes from health nuts who think self denial will accord them long life and countless other benefits, be they doctors or laymen who have nothing better to do. We ourselves have been through one of these tomes by a neurologist named David Perlmutter called Grain Brain: The Surprising Truth about Wheat, Carbs, and Sugar—Your Brain's Silent Killers.
You will notice that even the title is wordy. The trouble with such proselytizers is that they simply cannot do short diatribes, and we are hard pressed to know whether such ranting and raving relieves people of their addictions, or makes them into even more rampant consumers of bread and cakes and lord knows what else.
"Nearly twenty million people contend that they regularly experience distress after eating products that contain gluten, and a third of American adults say that they are trying to eliminate it from their diets." "Sales of gluten-free products will exceed fifteen billion dollars by 2016, twice the amount of five years earlier." Even though wheat formulation really has not changed over the last century, the incidence of celiac disease has increased fourfold, and the outbreak appears to be linked to gluten ingestion, although we do not know what else might be involved.
With celiac disease anyway, the cause of its increase does not seem related to the makeup of our wheat. "That suggested that whatever has happened with celiac disease has happened since 1950," Murray said. "The increase affected young and old people equally. These results imply that the cause is environmental."
Often gluten free products use additives that are worse than the gluten they are replacing. "You know, people are always dropping off samples of gluten-free products at our office. And when I eat them I regret it. I get heartburn. I feel nauseous. Because what are the things that sell food? Salt, sugar, fat, and gluten. If the makers take one away, then they add more of another to keep it attractive to people. If you don't have celiac disease, then these diets are not going to help you."
There is some suspicion that the addition of vital gluten to products already containing gluten may be responsible for some of the problems we associate with gluten. One bread maker has dumped the vital gluten. "Later that week, I flew back to New York, went home, and dumped my vital wheat gluten in the trash. I have returned to baking whole-wheat bread the way it is supposed to be made: water, yeast, flour, and salt."
We should note in general then that the gluten story is complicated, and simply cutting gluten does not eliminate the side effects that first cropped up circa 1950. But, we would emphasize, cutting the glutens is an immediate aid in losing weight, and most of us are carrying 20 to 30% more pounds than we should. (1-14-15)
280. A Revolution in Blood Testing
We spend billions on blood testing now. Drawing samples and getting the results consume hours and hours: often we do not get the test numbers for a week or more. Elizabeth Holmes, CEO of Theranos, is about to upset all that, giving comprehensive tests for a fraction of the time and money.
"From that one sample, Holmes said, several tests can be run, all less expensive than standard blood tests, sometimes as much as ninety per cent below the rates that Medicare sets. A typical lab test for cholesterol can cost fifty dollars or more; the Theranos test at Walgreens costs two dollars and ninety-nine cents." (1-14-15)
279. Controlling Cancer
There appears to be great progress in devising drugs that do not kill cancer cells but, rather, prompt the cells to develop into full-blown healthy cells instead.
"About fifteen per cent of all A.M.L. patients carry the mutated enzyme. In recent months, Stein had been participating in a Phase 1 clinical trial of a drug, AG-221, designed to target it; the drug was developed by the pharmaceutical company Agios. Phase 1 studies represent the very first tests of a new drug in humans; they are mainly meant to assess a new drug's safety, with little expectation that the treatment will help. Of the first ten patients who had been treated, three had died from their disease before the drug's effects could be evaluated. But the data on six of the seven remaining patients were striking: five had gone into complete remission and one entered a partial remission. (The other patient did not improve, and his leukemia continued to grow)."
"The Agios drug, instead of killing the leukemic cells—immature blood cells gone haywire—coaxes them into maturing into functioning blood cells. Cancerous cells traditionally have been viewed as a lost cause, fit only for destruction. The emerging research on A.M.L. suggests that at least some cancer cells might be redeemable: they still carry their original programming and can be pressed back onto a pathway to health."
"Agios hopes that AG-221 will become a key in treating those cancers which are driven by IDH-2. In March, the company launched clinical trials of another drug, AG-120, which targets a different mutated enzyme, IDH-1. The mutation occurs in as many as ten per cent of A.M.L. patients, but it's also found in seventy per cent of patients with a type of brain tumor called a glioma and in fifty per cent of cases of cancer of the cartilage. The treatment of cancer, which traditionally adopted a destroy-the-village strategy, is becoming ever more like precision warfare. "We treat people with the specific mutation who may benefit," David Schenkein, the C.E.O. of Agios, told me. "We don't treat people who would not respond to the drug."" (1-14-15)
278. Fecal Transplants
Fecal transplants now have achieved some currency as a treatment for Crohn's Disease. "Crohn's disease affects as many as seven hundred thousand Americans, but, like other autoimmune disorders, it remains poorly understood and is considered incurable. (Autoimmune disorders are thought to arise when the immune system attacks healthy tissue, mistaking it for a threat.) The standard treatments for Crohn's often don't work, or work only temporarily, and many have serious side effects. When the disease cannot be managed by drugs, surgery to remove part of the colon is often the only option."
"No one knows how many people have undergone fecal transplants—the official term is fecal microbiota transplantation, or FMT—but the number is thought to be at least ten thousand and climbing rapidly. New research suggests that the microbes in our guts—and, consequently, in our stool—may play a role in conditions ranging from autoimmune disorders to allergies and obesity, and reports of recoveries by patients who, with or without the help of doctors, have received these bacteria-rich infusions have spurred demand for the procedure. A year and a half ago, a few dozen physicians in the United States offered FMT. Today, hundreds do, and OpenBiome, a nonprofit stool bank founded last year by graduate students at M.I.T., ships more than fifty specimens each week to hospitals in thirty-six states. The Cleveland Clinic named fecal transplantation one of the top ten medical innovations for 2014, and biotech companies are competing to put stool-based therapies through clinical trials and onto the market. In medicine, at any rate, human excrement has become a precious commodity."
"it's possible that no Americans have gut microbiomes that are truly healthy. Evidence is mounting that over the course of human history the diversity of our microbes has diminished, and, in a recent paper, Erica and Justin Sonnenburg, microbiologists at Stanford, argue that the price of microbial-species loss may be an increase in chronic illness. Unlike our genes, which have remained relatively stable, our microbiome has undergone radical changes in response to shifts in our diet, our antibiotic use, and our increasingly sterile living environments, raising the possibility that "incompatibilities between the two could rapidly arise." In particular, the Sonnenburgs stress the adverse effects of a standard Western diet, which is notoriously light on the plant fibre that serves as fuel for gut microbes. Less fuel means fewer types of microbes and fewer of the chemical by-products that microbes produce as they ferment our food. Research in mice suggests that those by-products help reduce inflammation and regulate the immune system. Noting that rates of so-called Western diseases—including heart disease and autoimmune disorders, all of which involve inflammation—are thought to be much lower in traditional societies, the Sonnenburgs write, "It is possible that the Western microbiota is actually dysbiotic and predisposes individuals to a variety of diseases."
277. Alzheimer's in a Petri Dish
"For the first time, and to the astonishment of many of their colleagues, researchers created what they call Alzheimer's in a Dish a petri dish with human brain cells that develop the telltale structures of Alzheimer's disease." Nature just published a detailed account of the research.
"Of course, a petri dish is not a brain, and the petri dish system lacks certain crucial components, like immune system cells, that appear to contribute to the devastation once Alzheimer's gets started. But it allows researchers to quickly, cheaply and easily test drugs that might stop the process in the first place. The crucial step, of course, will be to see if drugs that work in this system stop Alzheimer's in patients."
"Dr. Tanzi is now starting an ambitious project to test 1,200 drugs on the market and 5,000 experimental ones that have finished the first phase of clinical testing a project that is impossible with mice, for which each drug test takes a year. With their petri dish system, Dr. Tanzi said, we can test hundreds of thousands of drugs in a matter of months." "
""This provides strong support to the amyloid hypothesis and essentially cinches the serial link between amyloid and intracellular tangles, Dr. Doraiswamy said. Now, he added, the challenge is to show that drugs that work in this system also help patients."" (10-15-14)
276. -new-Cool Bedroom Leads to Cool Sleep
"The cold temperatures, it turned out, changed the men's bodies noticeably. Most striking, after four weeks of sleeping at 66 degrees, the men had almost doubled their volumes of brown fat. Their insulin sensitivity, which is affected by shifts in blood sugar, improved. The changes were slight but meaningful, says Francesco S. Celi, the study's senior author and now a professor at Virginia Commonwealth University. These were all healthy young men to start with, he says, but just by sleeping in a colder room, they gained metabolic advantages that could, over time, he says, lessen their risk for diabetes and other metabolic problems. The men also burned a few more calories throughout the day when their bedroom was chillier (although not enough to result in weight loss after four weeks). The metabolic enhancements were undone after four weeks of sleeping at 81 degrees; in fact, the men then had less brown fat than after the first scan." (10-15-14)
275. Healing Through Art
"Researchers are learning more about the precise ways paintings and other works of art help patients and families in the healing process. With studies showing a direct link between the content of images and the brain's reaction to pain, stress, and anxiety, hospitals are considering and choosing artworks based on the evidence and giving it a higher priority than merely decoration for sterile rooms and corridors."
"One 1993 study found that patients exposed to a nature image experienced less postoperative anxiety and were more likely to switch to weaker painkillers than those who viewed an abstract image or no image." (8-27-14)
274. Fungi Breaking Out All Over
Strange Fungi Now Stalk Healthy People
A strange fungal disease in Canada and the U.S. heralds a new threat to human health
By Jennifer Frazer
Accident of Evolution Allows Fungi to Thrive in Our Bodies
How fungus makes people sick graphic
Map of outbreak areas
In 2001 dead porpoises with yeast-packed lungs washed up on the southeastern shore of Vancouver Island in British Columbia. The bloated organs were several times normal weight, with barely any room for air. The island's veterinarians had never seen anything like it. Cats and dogs there were having trouble breathing, too. In cats, the disease could cause a particularly gruesome symptom: weeping holes, produced when a yeast infection ate its way through the skull. At the same time, a few people on the island, located off Canada's Pacific Coast, also began falling ill with an unknown respiratory malady. They coughed constantly, their energy sapped, their sleep stolen. Chest x-rays revealed ominous lung or brain nodules. Biopsied tissue, however, proved the culprit to be not cancer but yeast.
Despite their varying symptoms, the pets, porpoises and humans all shared a single tormenter: Cryptococcus gattii. This fungus had never been seen on the island before, nor was it known to survive outside the tropics and subtropics. Now it was present in the environment, although no one knew where it had come from or how long it had been there. Most worryingly, no one knew how many would be sickened or how far the upstart yeast might travel.” (7-23-14)
273. Big Drop in Child Obesity
The “obesity rate for young children plummets 43% in decade.” “The trend came as a welcome surprise to researchers. New evidence has shown that obesity takes hold young: Children who are overweight or obese at 3 to 5 years old are five times as likely to be overweight or obese as adults.” “About 8 percent of 2- to 5-year-olds were obese in 2012, down from 14 percent in 2004.”
“She cautioned that these very young children make up a tiny fraction of the American population and that the figures for the broader society had remained flat, and had even increased for women over 60. A third of adults and 17 percent of youths are obese, the federal survey found. Still, the lower obesity rates in the very young bode well for the future, researchers said.” (3-5-14)
272. Drugs that Turn Out to Be Poisons
“NEW DELHI, India, the second-largest exporter of over-the-counter and prescription drugs to the United States, is coming under increased scrutiny by American regulators for safety lapses, falsified drug test results and selling fake medicines.” This and more shocking news about generic drugs widely sold in the United States appeared in “Medicines Made in India set Off Safety Worries.” Many formulations are weak, or totally ineffective, or harmful. China turns out to be a major supplier of bad components. (2-19-2014)
271. Gluten and Brain Disease
According to “This Is Your Brain on Gluten,” gluten and carbohydrates are the basis possibly of a nest of neurological diseases such as Parkinson’s, Alzheimer’s, ADHD, etc. The solution according to Dr. David Perlmutter, author of Grain Brain is to cut the glutens, which distort our diets. “Humans consume calories in the form of three macronutrients: carbohydrates, protein, and fat. Perlmutter describes the current U.S. diet as 60 percent carbs, 20 percent protein, and 20 percent fat. His ideal is close to that of the Paleo diet: 75 percent fat, 20 percent protein, and 5 percent carbs. He allows for up to 50 to 80 grams of carbs daily, which is about one serving of fruit. The heart of the diet is “good fats like olive oil, avocado, wild fish, organic nuts and nutrient-dense vegetables.”
“The gastroenterologists don’t seem to realize that gluten insensitivity far exceeds their area of focus. According to the work of Dr. Marios Hadjivassiliou in England, there are a large number of people who have reactions to gluten that have absolutely nothing to do with the gastroenterologist. Manifestations can occur anywhere in the body. The work of Dr. Alessio Fasano at Harvard indicates that perhaps all humans have some negative reaction to gluten. Gluten induces this cornerstone of brain degeneration: inflammation. It causes leakiness of the blood-brain barrier.” (1-15-14)
270. Drug Compounders Still Amuck
“The Food and Drug Administration has reported 14 multistate or national voluntary recalls so far this year of products made by so-called compounding pharmacies, which custom-mix large batches of medications not available from pharmaceutical companies. The FDA reported only two recalls of products from such pharmacies in 2012, including the recall of the injection behind the fungal-meningitis cases. There were none in the four years before that.”
“Meanwhile, doctors say they are struggling to cure patients because very little is known about a condition that normally affects plants, not people. More than 700 out of 14,000 people who received tainted injections have fallen ill since the outbreak began in September 2012, according to data released this month from the Centers for Disease Control and Prevention. That includes 86 cases diagnosed since the beginning of this year. Hundreds are still in treatment. Of those who have gotten sick, 63 have died, including 24 this year, the CDC said.”
“The slow pace of moves to tighten oversight and mounting case count underscores how long the effects of a deadly outbreak are lingering. The delayed response also illustrates how difficult it is to create a system meant to mitigate widespread compounding errors.A Senate bill that would give the FDA oversight of many large compounding pharmacies—which operate like manufacturers and sell drugs all over the country—is one of only a few pieces of legislation that may make it to the Senate floor this fall, according to Senate Democratic aides. Even if successful, it would be months, if not years, before enforcement took effect.”
“Meanwhile, the number of recalls of products at compounding pharmacies has mushroomed. Most recently, on Aug. 11, Specialty Compounding LLC of Cedar Park, Texas, voluntarily recalled all of its sterilized products after 15 people developed bloodstream infections caused by Rhodococcus equi, a bacteria, following injection with a mineral supplement used to treat conditions associated with low-calcium levels or for cardiac arrest.” (10-9-13)
269. Putting Fat People on the Thin Road
Researchers are now trying to see if they can alter the food buying habits of fat people by installing various visual clues within the supermarket buying experience. In “Wooing Us Down the Aisle,”we learn how Colin Payne, a New Mexico University professor, and other researchers are trying to steer food buyers away from the fat stuff and into healthy foods.
“The mirror is part of an effort to get Americans to change their eating habits, by two social scientists outmaneuvering the processed-food giants on their own turf, using their own tricks: the distracting little nudges and cues that confront a supermarket shopper at every turn. The researchers, like many government agencies and healthy-food advocates these days, are out to increase consumption of fruits and vegetables. But instead of preaching about diabetes or slapping taxes on junk food, they gently prod shoppers so gently, in fact, that its hard to believe the results. “
“In one early test at a store in Virginia, grocery carts carried a strip of yellow duct tape that divided the baskets neatly in half; a flier instructed shoppers to put their fruits and vegetables in the front half of the cart. Average produce sales per customer jumped to $8.85 from $3.99.
Here in El Paso a few months ago, the researchers focused on the floor, laying down large plastic mats bearing huge green arrows that pointed shoppers to the produce aisle. The outcome surprised no one more than the grocer.
In retail, the customer tends to go to the right, said Tim Taylor, the produce director for Lowes, Pay and Save, a regional grocery chain that let the scientists in to experiment with their arrows and mirrors. But I watched when the arrows were down, pointing left, and thats where people went: left, 9 out of 10.” (9-11-13)
268. -new- Turning Blood Testing Upside Down
“A Drop of Blood. An Instant Diagnosis.” “ The secret that hundreds of employees are now refining involves devices that automate and miniaturize more than 1,000 laboratory tests, from routine blood work to advanced genetic analyses. Theranos's processes are faster, cheaper and more accurate than the conventional methods and require only microscopic blood volumes, not vial after vial of the stuff. The experience will be revelatory to anyone familiar with current practices, which often seem like medicine by Bram Stoker.
A Theranos technician first increases blood flow to your hand by applying a wrap similar to one of those skiing pocket warmers, then uses a fingerstick to draw a few droplets of blood from the capillaries at the end of your hand. The blood wicks into a tube in a cartridge that Ms. Holmes calls a "nanotainer," which holds microliters of a sample, or about the amount of a raindrop. The nanotainer is then run through the analyzers in a Theranos laboratory. Results are usually sent back to a physician, but a full blood work-upmetabolic and immune markers, cell count, etc.was in my inbox by the time I walked out the door. “ This revolution in blood testing is the brainchild of Elisabeth Holmes, a dropout from Stanford who founded Theranos in 2003.
”Theranos is committing to a half-off discount on Medicare fees. "So a test that costs $100 now, we'll do $50 or less. The quote-unquote payer community I don't think has ever seen someone walk in and say we want to bill you at less than you're willing to reimburse," she says. If this strategy succeeds in squeezing down pricessay, lowering testing as a share of total health costs to 1.5% from 2.3% nowit could save Medicare $61 billion over 10 years and Medicaid $96.1 billion, according to what Theranos calls a conservative estimate.” (9-11-13)
267. Genetic Breakthrough on Cancer Drugs
“ An explosion in knowledge about the genetic mutations that cause tumors is just now offering the first real promise of drugs that can control what is the most-common and most-deadly cancer” (“Gene Breakthroughs Spark a Revolution in Cancer Treatment”)
“The same goes for other malignancies: Scientists have decoded tumor DNA from breast, colon, kidney, skin and other cancers in recent years to discover scores of variations they didn't know existed before.
Research hospitals like MD Anderson, Vanderbilt University and Massachusetts General Hospital are among a growing number of cancer practices that routinely decode the tumor DNA of most patients with advanced cancer.
The lists of newfound variations have invigorated the drug industry, with companies like Pfizer, Roche Holding AG ROG.VX +0.89%and Merck MRK +0.70%& Co. racing to develop drugs that target each one.
Last year, nearly 1,000 cancer drugs were in clinical development, up 52% from 2006, says the Pharmaceutical Research and Manufacturers of America, a trade group. The "vast majority" of that growth is from drugs targeted at genetic mutations, says Bill Chin, the group's head of science and regulatory affairs.” (9-11-13)
266. Testosterone Use Exploding
"The number of middle-aged men with prescriptions for testosterone is climbing rapidly, raising concerns that increasing numbers of men are abusing the powerful hormone to boost their libidos and feel younger, researchers reported on Monday.
Testosterone replacement therapy is approved specifically for the treatment of abnormally low testosterone levels, a condition called hypogonadism. The hormone helps build muscle, reduce body fat and improve sex drive. But a study published in the journal JAMA Internal Medicine found that many men who get prescriptions for the hormone have no evidence of a deficiency at all" (New York Times, June 4, 2013,p. D5) (8/14/13)
Update: Selling Testosterone
“Recommendations like Dr. Fisch’s and the marketing of low T as a common medical condition helped propel sales of testosterone gels, patches, injections and tablets to about $2 billion in the United States last year, according to IMS Health, a health care information company. In 2002, sales were reported to be a mere $324 million; around that time, Solvay Pharmaceuticals, which was then marketing AndroGel, began using the term low T, replacing a previous euphemism for male aging, andropause. Today the low-T trend is global. From 2000 to 2011, there was a major and progressive increase in testosterone use in 37 countries, according to a recent study published in the Medical Journal of Australia.” “Selling That New –Man Feeling” documents the over=the=top flogging that goes into testosterone promotion. (1-15-14)
265. Are Good Teeth Around the Corner?
Scientists have made stem cell advances that could lead to tooth regeneration and even to the end of tooth extractions, root canals, and cavity filling in a few years according to “Teeth That Replace Themselves.”
“Scientists have made advances in treating tooth decay that they hope will let them restore tooth tissueand avoid the painful dental procedure. Several recent studies have demonstrated in animals that procedures involving tooth stem cells appear to regrow the critical, living tooth tissue known as pulp.
Treatments that prompt the body to regrow its own tissues and organs are known broadly as regenerative medicine. There is significant interest in figuring out how to implement this knowledge to help the many people with cavities and disease that lead to tooth loss.”
“Some scientists have focused on growing entirely new teeth. More are focused on trying to grow healthy new pulp inside the hard shell of tooth enamel, either by stimulating or encouraging stem cells or by better controlling the inflammation that goes on in the mouth in response to an infection.” (7-10-13)
264. Dangerous Flu: Just Over the Horizon: H7N9 and MERS
One of our correspondents has pointed out that rather dangerous flu bugs are gaining strength in Asia and the Middle East, including avian flu which never quite disappeared:
“At the time we first talked about it in 2005, I was following the H5N1 avian influenza virus that was sickening people in Asia and Africa and had a high fatality rate. That virus is still bubbling around and attracting occasional attention, but has yet to gain the ability to readily infect humans and thus jump from one infected person to another. This new flu though, H7N9, has really attracted my attention. It came up fast, spread quickly into a number of different regions in China and seemed much better configured to spread from human to human than was H5N1. Right now it has receded into the shadows, apparently because of the seasonal change in weather, but that doesnt mean that it has gone away. It has become quiet, but may well come back as we head back into winter.
Interestingly, while we had our eyes on H7N9, a different and perhaps more daunting threat/challenge arose, and that is a novel corona virus that has popped up in the Middle East. It is now being called Middle East Respiratory Syndrome novel Corona Virus or MERS for short. There have been a number of MERS cases in Saudi Arabia, the apparent epicenter. This is not an influenza, it is more akin to SARS. It kills folks at an alarming rate. The experts don’t know the animal reservoir, although they think it could be bats. The virus apparently takes a long time to incubate (10-12 days), so once someone is infected they can move around quite a bit, spreading the disease, without anyone knowing. There have now been cases in France and England as well as a number of countries in the Middle East (Morocco is the latest in the last day or so). Worse, it seems to transmit much more readily from human to human and there have been several clusters in hospitals, including health care workers. I have always thought that healthcare workers getting sick was a canary in the coal mine sentinel event. MERS has not yet grown to large case numbers, and it may not, but it is just as scary, if not more so, than H7N9. It does not seem to be as easily controlled by changes in climate as do the flus. If it continues to percolate in the Kingdom of Saudi Arabia (KSA), there is a lot of concern that the upcoming Hajj, with millions of pilgrims coming in and then dispersing, will be the perfect mechanism for spread. Here is a basic article from National Geographic: http://news.nationalgeographic.com/news/2013/05/130530-mers-cov-virus-nathan-wolfe-pandemic Also, here is a link to a more recent news-type story on this: http://www.nydailynews.com/life-style/health/sounds-alarm-middle-eastern-virus-article-1.1356950 The money section is as follows:
Calling it a threat to the entire world, the head of the World Health Organization sounded the alarm over the Middle Eastern virus that has so far killed 24 people.
Speaking on Monday in Geneva at the global health monitors annual conference, Dr. Margaret Chan did not mince words about the SARS-like novel coronavirus that researchers call MERS.
Looking at the overall global situation, my greatest concern right now is the novel coronavirus. We understand too little about this virus when viewed against the magnitude of its potential threat. Any new disease that is emerging faster than our understanding is never under control, Dr Chan said. These are alarm bells and we must respond. The novel coronavirus is not a problem that any single affected country can keep to itself or manage all by itself. The novel coronavirus is a threat to the entire world.
One day after Chan’s speech, health officials in France announced the death of a 65-year-old man who had apparently contracted the MERS virus after traveling to Dubai.
Looking at the two situations, it is interesting to note how well the Chines authorities have behaved with H7N9. They learned a lot from the opaque days of the SARS crisis and have been quite transparent, both socially and scientifically. They have shared news and samples and accepted scientific help from around the world. On the other hand, KSA has been very closed and unwilling to share info. I think that one of the things that concerns people with MERS is that the Saudis do not have the tools, power or expertise to stop this by themselves and it could quickly get out of hand. (June 26, 2012)
Update: More on MERS
Max Wallace, a health industry executive, has been following virus outbreaks around the world and amplifies our understanding of MERS: “Laurie Garrett provides more insight in “The Middle East Plague Goes Global.” It looks at MERS in the social/political context of Saudi Arabia, with the Hajj and Umrah coming, among other things, and also in the context of Syria and its civil war-driven breakdown of infrastructure. We have become accustomed to thinking of Asia, and particularly China, as the mixing vessel for new types of influenza. China is quiet right now because flu is highly impacted by seasonal climate change. While flus like H5N1 and H7N9 with pandemic potential are still simmering in Asia, we won’t really know any more until northern hemisphere flu season kicks back in. MERS is a different thing entirely. It isn’t a flu, it is more akin to the SARS virus that was so scary. It obviously isn’t affected by warm weather like flu – after all it is showing up in Saudi Arabia in July. We don’t know where it comes from, how to effectively test for it, its animal reservoirs (bats? camels?), how long its incubation period is, how it transmits or how to effectively treat it. Add in the socio-political factors covered outlined by Garret and her co-author in this article and you have the potential for a very dangerous situation to develop.”
There is a fairly determined effort to determine the animal origins of MERS as noted in “Solving a Viral Mystery,’ New York Times, July 2, 2013. “The disease almost certainly originated with one or more people contracting the virus from animals—probably bats—but scientists do not know how many times that kind of spillover to humans has occurred, or how likely it is to keep happening.” (7-10-13)
Update: MERS Pandemic?
An August 2013 Lancet article sort of concludes that a pandemic is not right around the corner. “However, the analysis by Breban and colleagues4 concludes that MERS-CoV in its current guise is unlikely to cause a pandemic.”
But our virus watcher tells us to be aware of the qualifier “in its current guise.” Max Wallace suggests that rather deadly mutations can spring up:
“The phrase in its current guise is the kicker.
The thing that makes this a bit worrisome is the ability/propensity of the virus (and all viruses) to mutate. MERS=CoV has already shown an ability to infect humans. We also know that there are hidden asymptomatic or low-symptom cases where humans (and probably animals) are carrying the virus. Further, we don't even really know which animals are truly infected -- we now think bats and perhaps camels are the reservoirs/vectors, but there may be more. H7N9 and H5N1, similarly dangerous viruses, are now bubbling along in China and Southeast Asia in birds and pigs as well as humans. These infected animals and humans are excellent mixing vessels where random viral genetic reassortments and mutations routinely take place. There are billions/trillions of virus particles propagating daily within billions/trillions of cells, and they don't all have to mutate, just some. Most mutations wont matter. The risk is that some might. And, we know that these three viruses, all of which have high case fatality rates, have already shown some ability both to infect humans and to achieve human to human (and even human to human to human) transmission. All a mutation would have to do to make a virus pandemic-capable is to make that virus just a bit more infective for humans to boost that R0 number referenced in the article just a little. There have been controversial experiments done in the Netherlands with H5N1 to see what would make that virus more effectively infective in humans and the answer is not much. There is now talk of the same researchers and others doing similar experiments with MERS-CoV. We will soon know. What concerns me even more than these scientific experiments is that the bats, camels, pigs and birds are already doing their own more basic experiments and one day we might be surprised by the outcome.
So, we don’t have a pandemic now. Is there the potential for one? Absolutely. Is it likely? Absolutely again, it is actually almost certain. It is just that no one can predict the timing of such an event or even which virus will eventually have the right characteristics.” (9-11-13)
Update: Camel Carriers
Apparently camels are a principal vehicle for spreading MERS to human beings. “The new study provides the first evidence that the virus is widespread in dromedary camels (the kind with one hump) in Saudi Arabia, and has been for at least 20 years.”
“Researchers do not know how camels become infected, but they suspect that the virus may have originally come from bats. MERS belongs to the coronavirus family, like SARS, the deadly and more contagious respiratory infection that began in China and caused a global outbreak in 2003. Bats are a host for SARS and other coronaviruses, and studies have found evidence linking MERS to bats.” (3-5-14)
263. Coffee Yes, Coffee No
There have been a rash of studies and articles lately extolling the health benefits of coffee and caffeine. “Good News in the Daily Grind” in the Wall Street Journal probably gives us a balanced way to look at coffee. Yes, it seems to provide a whole nest of benefits. But it can exacerbate problems in people with certain conditions. So caution is still in order. Here is a quick take from the Journal:
· Diabetes: Many studies find that coffee—decaf or regular—lowers the risk of developing Type 2 diabetes, but caffeine raises blood sugar in people who already have it.
· Cancer: Earlier studies implicating coffee in causing cancer have been disproven; may instead lower the risk of colon, mouth, throat and other cancers.
· Heart disease: Long-term coffee drinking does not appear to raise the risk and may provide some protection.
· Hypertension: Caffeine raises blood pressure, so sufferers should be wary.
· Cholesterol: Some coffee—especially decaf—raises LDL, the bad kind of cholesterol.
· Alzheimer's: Moderate coffee drinking appears to be protective.
· Osteoporosis: Caffeine lowers bone density, but adding milk can balance out the risk.
· Pregnancy: Caffeine intake may increase the risk of miscarriage and low birth-weight babies.
· Sleep: Effects are highly variable, but avoiding coffee after 3 p.m. can avert insomnia.
· Mood: Moderate caffeine boosts energy and cuts depression, but excess amounts can cause anxiety.
Source: WSJ (June 26, 2012)
262. Do Vitamins Kill?
“Don’t Take Your Vitamins” is a very provocative opinion essay authored by Paul A. Offit, chief of the infectious diseases division of the Children’s Hospital of Philadelphia. He points to a clutch of miscellaneous studies that suggest that certain vitamins when taken in quantity seem to correlate with decreased instead of increased lifespans. Unfortunately, too, vitamins are exempted from Federal regulation by Congressional mandate so there is no body really looking into their safe use. While Offit is over the top, users should remember the words “Caveat emptor.”
“In December 1972, concerned that people were consuming larger and larger quantities of vitamins, the F.D.A. announced a plan to regulate vitamin supplements containing more than 150 percent of the recommended daily allowance. Vitamin makers would now have to prove that these megavitamins were safe before selling them. Not surprisingly, the vitamin industry saw this as a threat, and set out to destroy the bill. In the end, it did far more than that.
Industry executives recruited William Proxmire, a Democratic senator from Wisconsin, to introduce a bill preventing the F.D.A. from regulating megavitamins. On Aug. 14, 1974, the hearing began” So spurious promises and low-grade vitamins have littered the marketplace. (6-12-13)
261. Using Tobacco
Tufts’ Vascular Biology Laboratory focuses on the role of foods in two areas in particular: the formation of blood vessels and the development of cardiovascular disease. It is headed up by Mohsen Meydani.n (Tufts Magazine, Fall 2010, pp.8-9 and Tufts Journal.)
“The lowdown on turmeric is that its main bioactive component—curcumin—may indeed promote good health. In fact, Meydani has discovered some new properties. First, curcumin may help people lose weight. That’s based on studies of mice, in which a curcumin-rich diet appeared to have a significant slimming effect. And second, the substance appears to help keep arteries healthy.
The idea of testing curcumin for weight control was a matter of putting two and two together. Meydani knew that curcumin inhibits angiogenesis, the growth of blood vessels. In cancer research, the effect has been exploited to impede tumors.
He also knew that mice genetically engineered for obesity can avoid getting fat if they are injected when young with an anti-angiogenic drug, as has been shown in research at Harvard. “We figured we could make a connection here,” says Meydani. “We know that curcumin is anti-angiogenic. So let’s see what effect it has on weight gain.” After all, he says, fat cells, like tumors, need blood to grow.
A Steady Diet of Curcumin
The lowdown on turmeric is that its main bioactive component—curcumin—may indeed promote good health. Photo: iStock
He and his team gathered up some four-week-old lab mice and had them eat a veritable McDonald’s diet of fat-laden meals. Half the mice also consumed small amounts of curcumin—the human equivalent of a spoonful or two of turmeric daily. After 12 weeks, the curcumin-fed mice weighed, on average, some 10 percent less than the others.” (April 24, 2013)
260. Using Tobacco Plants to Make Flu Vaccine
“Currently, the majority of the 130 million seasonal flu vaccine doses administered in the US every year are made using live chicken embryos. But the process is costly, time-consuming, and requires a lot of eggs.”
“So Medicago, a Canadian pharmaceutical company, is testing a new idea: Coax tobacco plants into expressing the proteins to make vaccines. Last year Darpa challenged the firm to make 10 million doses in a month. Medicago succeeded, proving it can respond quickly to a new outbreak—much faster than the six months required for egg-based vaccines. This is how the tobacky gets wacky.”
(March 27, 2013)
259. Bee Venom May Kill AIDS
“Nanoparticles carrying a toxin found in bee venom can destroy human immunodeficiency virus (HIV) while leaving surrounding cells unharmed, researchers at Washington University School of Medicine in St. Louis have show. The finding is an important step toward developing a vaginal gel that may prevent the spread of HIV, the virus that causes AIDS.” (Science Daily)
“Bee venom contains a potent toxin called melittin that can poke holes in the protective envelope that surrounds HIV, and other viruses. Large amounts of free melittin can cause a lot of damage. Indeed, in addition to anti-viral therapy, the paper's senior author, Samuel A. Wickline, MD, the J. Russell Hornsby Professor of Biomedical Sciences, has shown melittin-loaded nanoparticles to be effective in killing tumor cells.
“The new study shows that melittin loaded onto these nanoparticles does not harm normal cells. That's because Hood added protective bumpers to the nanoparticle surface. When the nanoparticles come into contact with normal cells, which are much larger in size, the particles simply bounce off. HIV, on the other hand, is even smaller than the nanoparticle, so HIV fits between the bumpers and makes contact with the surface of the nanoparticle, where the bee toxin awaits.” (3/13/13)
258. Polysaturated Fats—Good or Bad?
Polysaturated fats may lower your cholesterol but shorten your life if we are to believe an Australian study.
“Researchers with the National Institutes of Health and other organizations recently resurrected the results of a long-overlooked Australian study conducted from 1966 to 1973, in which one group of men with heart disease increased omega-6-rich polyunsaturated fat intake to 15 percent of calories, while reducing saturated fat intake to less than 10 percent. Another group of men with heart disease continued their normal diets.
“The men were followed for an average of 39 months, and those on the polyunsaturated-rich diet lowered their cholesterol levels by an average of 13 percent. But they also were more likely to die, and in particular to die of a heart attack, than those who stuck with their usual diet, which consisted of about 15 percent saturated fat.
“This study the results of which weren't fully analyzed when it was conducted in the early days of enthusiasm for polyunsaturated oils adds to a small but unsettling body of data suggesting that consuming polyunsaturated oils, even though they reliably lower cholesterol, may nevertheless increase your risk of heart disease.”
Alas, we must ask, “To go (fish) oil or not.” (3/13/13)
257. Cancer: Souping Up The Immune System
Ralph Steinman pulled off two miracles. First, he completed the first major test of his theory that one could slice and dice cancer and test its genetic structure so as to build a personalized therapy specifically designed for one patient. The test, it turns out, he did on himself, having come down with pancreatic cancer. Indeed, the gene therapy when wedded to other approaches clearly prolonged his life, although it uncertain just how much the effort to plug into the immune system had to do with the outcome. Secondly, he won the Nobel Prize, but got it after his death. The Nobel establishment does not give awards to the deceased, but it only found out about his passing a few days after giving the prize. It was too chagrined to claw back the award. We learn about all this in "Is the Cure for Cancer Inside You?"
The first step was to cut out his tumor, chop into pieces, and then send it to researchers across the land to find its exact weak spots and to come up with a custom therapy. "The mass was big enough that Schlesinger could get through all the items on the list. In the days, weeks and months that followed, Steinmans cancer was sent to labs in Boston and Baltimore, Toronto and Tbingen, Germany, Dallas and Durham, N.C. With help from friends and former students, he would squeeze every bit of data from his cancer that he could."
"This personalized approach to treating cancer, which subdivides the classic types according to distortions in their genes, has been growing at a rapid pace. In the past few years, laboratories financed by the government have set out to build a comprehensive atlas of the cancer genome to collect 500 tumors from each of 25 kinds of the disease and then to analyze their DNA and RNA at a cost of more than $100 million a year. The advent of inexpensive genome sequencing has produced a gold rush in the commercial sector, too, with the promise that anyone's tumor can be sliced and processed and analyzed, until its genetic fingerprint is decoded."
'''The same vaccines that Steinman received have shown promise in other patients. The irradiated-cell approach may increase survival for some patients with metastatic prostate cancer. A team based at Baylor University in Dallas has found encouraging results for reinfused dendritic cells in Stage 4 melanoma. But for the man who would later win the Nobel Prize for discovering dendritic cells, would these treatments work at all?''
"Steinman knew he wouldn't live to see that field reach its full potential. It has been almost 40 years since he discovered the dendritic cell, and doctors have only now begun to make immunotherapies that work. By all accounts, that sluggish pace was deeply frustrating to Steinman, even before he got sick. His mind went so fast, and he always wanted everything done yesterday, Schlesinger says. Years ago, the two of them were on their way to their lab, and Steinman was in a foul mood because a trial they hoped to run was taking longer than expected. After some back and forth about the details, he stopped to consider what he had accomplished in his long career. He said to me, You know, all this time has gone by, and we haven't cured cancer or found a vaccine for H.I.V. And then he paused, and told her, "We've got to get to work.""
256. Rethinking Bacteria
Every grade schooler in 20th century America was drilled in the germ theory of disease, learning that bacteria were our enemies, something to be avoided through copious washing, by avoiding germy environments, by ingesting huge quantities of antibiotics when colds or minor infections or other discomforts struck. Even today a Wall Street Journal will feature a primer on germs ("Calling All Germs") which tells us all those nostrums we use to kill germs are only half effective and the real way to eradicate them is with a liberal swabbing of isopropyl alcohol. Germs or bacteria, we are given to understand, are enemies of mankind, something to be fought off at all costs.
Trouble is, it ain't so simple. Many bacteria help us thrive, many are neutral, and, in toto, they form a live web that is vital to life. Michael Specter's "Germs Are Us" show them to be part and parcel of what makes us flourish. Antibiotics, which can mow down bacteria, are helping to fight certain diseases, but, in fact, often destabilize human beings, because they can obliterate so many bacteria that are critical to our health and happiness.
In time microbiologists think they may able to usefully tinker with the body's bacterial network so as to enhance the microbiome in ways that not only fight off what we commonly call disease but help a whole slew of bodily processes that are critical to good day-to-day living.
Update: Pollan Discovers Bacteria
Over the past two years there has been a flood of commentary on how the bacteria that populates the earth and in particular clings to the human frame, far outnumbering the cells that we treat as the basis of human life. Turns out, we need lots of good bacteria, too. The pop intellectual Michal Pollan has gotten in on this trendy thinking, most recently in an article for The New York Times entitled “Some of My Best Friends are Bacteria.”
“Here were the names of the hundreds of bacterial species that call me home. In sheer numbers, these microbes and their genes dwarf us. It turns out that we are only 10 percent human: for every human cell that is intrinsic to our body, there are about 10 resident microbes including commensals (generally harmless freeloaders) and mutualists (favor traders) and, in only a tiny number of cases, pathogens. To the extent that we are bearers of genetic information, more than 99 percent of it is microbial. And it appears increasingly likely that this second genome, as it is sometimes called, exerts an influence on our health as great and possibly even greater than the genes we inherit from our parents. But while your inherited genes are more or less fixed, it may be possible to reshape, even cultivate, your second genome.”
“Preliminary results indicate that a pristine microbiome of people who have had little or no contact with Westerners features much greater biodiversity, including a number of species never before sequenced, and, as mentioned, much higher levels of prevotella than is typically found in the Western gut. Dominguez-Bello says these vibrant, diverse and antibiotic-nave microbiomes may play a role in Amerindians markedly lower rates of allergies, asthma, atopic disease and chronic conditions like Type 2 diabetes and cardiovascular disease.” (05-23-13)
255. The Secret of Long Life
Ikaria. This a Greek island where an uncommon number of the residents live to very ripe old ages. Dan Buettner, the Blue Zones(amazon and infinite bookstore) author, is unsure as to why they do, though he suggests in "The Enchanted Island of Centenarians" that diet and a relaxing life style have a lot to do with it.
"Dr. Ioanna Chinou, a professor at the University of Athens School of Pharmacy, is one of Europe's top experts on the bioactive properties of herbs and natural products. When I consulted her about Ikarians' longevity, she told me that many of the teas they consume are traditional Greek remedies. Wild mint fights gingivitis and gastrointestinal disorders; rosemary is used as a remedy for gout; artemisia is thought to improve blood circulation. She invited me to give her samples and later tested seven of the most commonly used herbs on Ikaria. As rich sources of polyphenols, they showed strong antioxidant properties, she reported. Most of these herbs also contained mild diuretics. Doctors often use diuretics to treat hypertension perhaps by drinking tea nightly, Ikarians have gently lowered their blood pressure throughout their lives."
"Seeking to learn more about the islands' reputation for long-lived residents, I called on Dr. Ilias Leriadis, one of Ikaria's few physicians, in 2009. On an outdoor patio at his weekend house, he set a table with Kalamata olives, hummus, heavy Ikarian bread and wine. People stay up late here, Leriadis said. "We wake up late and always take naps. I don't even open my office until 11 a.m. because no one comes before then." He took a sip of his wine. "Have you noticed that no one wears a watch here? No clock is working correctly. When you invite someone to lunch, they might come at 10 a.m. or 6 p.m. We simply don't care about the clock here." "
"Chrysohoou also suspected that Ikarians' sleep and sex habits might have something to do with their long life. She cited a 2008 paper by the University of Athens Medical School and the Harvard School of Public Health that studied more than 23,000 Greek adults. The researchers followed subjects for an average of six years, measuring their diets, physical activity and how much they napped. They found that occasional napping was associated with a 12 percent reduction in the risk of coronary heart disease, but that regular napping at least three days weekly was associated with a 37 percent reduction. She also pointed out a preliminary study of Ikarian men between 65 and 100 that included the fact that 80 percent of them claimed to have sex regularly, and a quarter of that self-reported group said they were doing so with good duration and achievement."
"Social structure might turn out to be more important. In Sardinia, a cultural attitude that celebrated the elderly kept them engaged in the community and in extended-family homes until they were in their 100s. Studies have linked early retirement among some workers in industrialized economies to reduced life expectancy. In Okinawa, there's none of this artificial punctuation of life. Instead, the notion of ikigai — "the reason for which you wake up in the morning" — suffuses people's entire adult lives. It gets centenarians out of bed and out of the easy chair to teach karate, or to guide the village spiritually, or to pass down traditions to children. The Nicoyans in Costa Rica use the term plan de vida to describe a lifelong sense of purpose. As Dr. Robert Butler, the first director of the National Institute on Aging, once told me, being able to define your life meaning adds to your life expectancy."
Most of the schemes of diet companies get around to portion control. But Lifesize has made it a little easier. Its plastic measuring devices help dieters ingest the right amount of carbs and proteins. The partners call it dieting for dummies. We have said elsewhere that sustained weight control seems most dependent on constant physical movement of the dieter during the whole of the day. And, further, that weight and health correlate more with a whole host of behaviors that the diet fad people fail to focus on.
Cocktails for Gout
It is much more fun to read Britain's premier medical journal—Lancet- than the New England Journal of Medicine or our other medical publishing outlets. For instance, we have just been through a delightful historical tale that traces the birth of cocktails to an effort to rein in gout. The goutiest chap we ever have met had his delightful downfall many nights of the week at one of New York's fun steakhouses. They had the lobster and the booze waiting, both of which did him wrong.
Of course, he should have picked up his Lancet where he could have perused "Bitter Medicine: Gout and the Birth of the Cocktail:"
"Sydenhams Treatise on the Gout, published in 1683, argued that gout was the result of ease, voluptuousness, high living, and too free an use of wine and other spirituous liquors. Bleeding and purging could, he thought, be counterproductive, driving
peccant humours further into the extremities. Instead he recommended a light diet, plenty of fluid, and regular doses of a digestive remedy he called bittersdistilled
alcohol infused with watercress, horseradish, wormwood, and angelica root.
Sydenhams bitters became a popular remedy for gout not least because they gave sufferers an excuse to take nips of strong spirit during attacks and other
practitioners sought to emulate their success."
"And in 1783 Nicholas Husson, an officer in the French army, began to sell bitters that included an extract of meadow saffron, Colchicum autumnaleone component of which, colchicine, is now known to block the metabolic pathways that cause gout."
"By the late 19th century, however, the most popular bitters were not home-brewed, but made by two companies: Peychaud and Angostura"
David Murdock's Live Forever Diet
David Murdock, rich collector, owner of Lanai, proprietor of large food companies(Dole), and real estate impresario, is studying and practicing how to live forever. He is eating right, to the best of his knowledge, and he is funding serious research on how to live the good and long life.
"His affluence has enabled him to turn his private fixation on diet and longevity into a public one. I went to see him first in North Carolina in late January. It is there, outside of Charlotte, in a city named Kannapolis near his lodge, that he has spent some $500 million of his fortune in recent years to construct the North Carolina Research Campus, a scientific center dedicated to his conviction that plants, eaten in copious quantities and the right variety, hold the promise of optimal health and maximal life span."
"Across the street is a hotel, completed in 2006 and operated by the Four Seasons, that Murdock built to house the California Health and Longevity Institute, a combination medical suite, spa and demonstration kitchen. Clients can be screened for various cancers, have their body fat measured inside a special pod and get an earful about quinoa, along with a cooking tutorial. On the hotels room-service menus, in place of heart-shaped symbols designating low-cholesterol selections, there are L-shaped symbols designating dishes that might, by dint of fiber or antioxidants or omega-3 fatty acids, promote longevity. The hummus wears such a tag; so does the multigrain penne with a meatless tomato sauce"
A Salty Story
Everyday we are learning the foods once thought to be deadly are man's best friend. Coffee, once reviled as the home of caffeine and bad dreams, is now thought to be a catalyst for health in many ways. Many Sundays ago, just as we were going to down very white sourdough bread and eggs and coffee and butter, we learned "The Truth about Salt" or "Salt, We Misjudged You."
"While, back then, the evidence merely failed to demonstrate that salt was harmful, the evidence from studies published over the past two years actually suggests that restricting how much salt we eat can increase our likelihood of dying prematurely. Put simply, the possibility has been raised that if we were to eat as little salt as the U.S.D.A. and the C.D.C. recommend, we'd be harming rather than helping ourselves."
"One could still argue that all these people should reduce their salt intake to prevent hypertension, except for the fact that four of these studies involving Type 1 diabetics, Type 2 diabetics, healthy Europeans and patients with chronic heart failure reported that the people eating salt at the lower limit of normal were more likely to have heart disease than those eating smack in the middle of the normal range. Effectively what the 1972 paper would have predicted."
In other words, concludes Gary Taubes, there is precious little evidence that salt does all the disastrous things to us the nutritionists like to claim, that salt consumption is remarkably stable anyway, and that the lack of salt can be impairment to health.
250. Fighting Bugs and Mosquitoes
"In truth, flies will get into the house no matter what you do. This is especially true in the fall, when flies come in from the cold…" (New York Times, November 10, 2011, p.D6).Most of the devices people use to fight the common housefly are for naught, though obvious things do help, such as covering garbage cans tightly, barring obvious passages to the outside, etc.
Some progress is being made with mosquitoes. Organic garden services report that garlic sprays do have a dampening effect on mosquito populations. A number of householders report a fair amount of success with Mega-Catcher, a mosquito-killing device from New Zealand.
Slate has done a wonderful series on walking, telling us Americans don't do enough of it and telling us how much it helps us. Further, author Tom Vanderbilt has appeared on PBS to spread his gospel about walking. The Slate series comes in four parts—The Crisis in American Walking, Sidewalk Science, What's Your Walk Score?, and Learning to Walk.
"The United States walks the least of any industrialized nation. Studies employing pedometers have found that where the average Australian takes 9,695 steps per day (just a few shy of the supposedly ideal "10,000 steps" plateau, itself the product, ironically, of a Japanese pedometer company's campaign in the 1960s), the average Japanese 7,168, and the average Swiss 9,650, the average American manages only 5,117 steps. Where a child in Britain, according to one study, takes 12,000 to 16,000 steps per day, a similar U.S. study found a range between 11,000 and 13,000."
"More important than the technology, though, is the idea that Walk Score has quantified walkability, taken an abstract quality—you know it when you see it, sort of—and turned it into something that can be measured against other addresses, other neighborhoods, even other cities (witness the New York versus San Francisco World Series of Walking). Walk Score gets people thinking concretely about walking. "Urban planners have been talking about walkability for a long time, but it's hard to get people to pay attention," says Lerner. "But because the scores are so personal, it's gotten people to pay attention."
"While walking-challenged small suburban communities have been the most frequent adopters of Complete Streets' guidelines, even walkable cities like New York, San Francisco, and Chicago—where generations of spatial concessions to the car have downgraded the pedestrian experience—are embracing a complete-streets mentality. Interestingly, what's driving much of this activity is a renewed interest not simply in walking as a transportation mode, but in health. The notion of walking as an anti-obesity measure, among other things, has moved the Centers for Disease Control to support "active transportation." And some cities are supporting walking with an epidemiological approach: Rather than viewing pedestrian injuries as random accidents to be blamed on wayward jaywalkers, cities are now employing health professionals to pinpoint where and why people walking are injured."
Fat Stuff: Theories of Obesity
The trouble with the really bad diseases, the chronic ones, the ones that hang with us no matter what we do, is they have many causes, not just one. Such is obesity. That's why it is much easier to put on weight, than to lose it. Once you are fat, all sorts of body processes go to work to keep you from losing. "Researchers in a relatively new field are looking at the role of industrial chemicals and non-caloric aspects of foods -- called obesogens -- in weight gain. Scientists conducting this research believe that these substances that are now prevalent in our food supply may be altering the way our bodies store fat and regulate our metabolism," though not all researchers agree.
"Bruce Blumberg, professor of developmental and cell biology and pharmaceutical sciences at the University of California, Irvine, who coined the term "obesogen," studies the effect that organotins -- a class of persistent organic pollutants that are widely used in the manufacture of polyvinylchloride plastics, as fungicides and pesticides on crops, as slimicides in industrial water systems, as wood preservatives, and as marine antifouling agents -- have on the body's metabolism. Organotins, which he considers to be obesogens, "change how your body responds to calories," he says. "So the ones we study, tributyltin and triphenyltin, actually cause exposed animals to have more and bigger fat cells. The animals that we treat with these chemicals don't eat a different diet than the ones who don't get fat. They eat the same diet -- we're not challenging them with a high-fat or a high-carbohydrate diet. They're eating normal food, and they're getting fatter." But others say that just the calories matter. For more, see "What's Really Making Us Fat," in the Atlantic.
Exercise and Long Life
Researchers are beginning to understand why lots of exercise leads to long life. "As doctors never tire of reminding people, exercise protects against a host of illnesses, from heart attacks and dementia to diabetes and infection.
How it does so, however, remains surprisingly mysterious. But a paper just published in Nature by Beth Levine of the University of Texas Southwestern Medical Centre and her colleagues sheds some light on the matter. Dr Levine and her team were testing a theory that exercise works its magic, at least in part, by promoting autophagy. This process, whose name is derived from the Greek for "self-eating", is a mechanism by which surplus, worn-out or malformed proteins and other cellular components are broken up for scrap and recycled"
Autophagy is an ancient mechanism, shared by all eukaryotic organisms (those which, unlike bacteria, keep their DNA in a membrane-bound nucleus within their cells). It probably arose as an adaptation to scarcity of nutrients. Critters that can recycle parts of themselves for fuel are better able to cope with lean times than those that cannot. But over the past couple of decades, autophagy has also been shown to be involved in things as diverse as fighting bacterial infections and slowing the onset of neurological conditions like Alzheimer's and Huntington's diseases.
Most intriguingly of all, it seems that it can slow the process of ageing. Biologists have known for decades that feeding animals near-starvation diets can boost their lifespans dramatically. Dr Levine was a member of the team which showed that an increased level of autophagy, brought on by the stress of living in a constant state of near-starvation, was the mechanism responsible for this life extension.
The theory is that what are being disposed of in particular are worn-out mitochondria. These structures are a cell's power-packs. They are where glucose and oxygen react together to release energy. Such reactions, though, often create damaging oxygen-rich molecules called free radicals, which are thought to be one of the driving forces of ageing. Getting rid of wonky mitochondria would reduce free-radical production and might thus slow down ageing." Economist and also see Nature.
This research has more implications than the authors may understand. As we age, we seem in general to have a harder time getting rid of all sorts of wastes in our body and even in usefully processing various things we ingest. In theory, at least, we will have to look for mechanisms that will better help the body flush out all sorts of wastes as we begin to solve some of the riddles that aging presents.
Obesity: Easy to Gain; Hard to Lose
Kevin Hall of the NIH has shown that taking off weight is no easy matter and the standard tactic of cutting 500 calories out of your daily diet usually will not do the trick. The body's metabolism changes as you add weight, and the formula for losing also varies according to how much fat and muscle mass adorns one's skeleton. Hall also shows that it is all too easy to gain weight. That is, "a surprisingly small imbalance, just ten extra calories day, has driven the 9kg jump in the average American's weight over the past 30 years." See Economist and Lancet. Also see other significant obesity articles in same issue of Lancet.
245. Starter Kit on Sleep from Harvard
This site is not up to par for the Harvard Medical School. So don't expect a lot. But there are little tidbits tucked away here that will interest the casual inquirer—whether a science buff or a no-sleep sufferer. For instance, we liked the Glossary. This sleeper is called Healthy Sleep. For a source who combines a popular touch and yet combines it with academic wisdom, look to Peter Maas at Cornell. Sleeplessness is as epidemic in our society as depression, and is often linked to it. Both in fact are maladies where the science is still primitive, and the sleep centers, even the reputable ones, often cannot do much for the sleep deprived. That said, there is a need for a select list of the sleep institutes that really count, especially since there is a horde of schlock outfits around that cater to the unwary. Such a list and a simple list of some of the rudimentary things one can do to boost one's sleep would be a help.
244. Maybe a Little B12 Will Bring You Back
Quite often we may think an oldster is suffering from Alzheimer's or some other devastating complaint of old age, when all he or she lacks is a shot of vitamins. Jane Brody finds that a raft of symptoms can be attributed to B12 deficiency. Til Jane came along and told us B12 is good for everything that ails you, we just thought of it as a quick picker-upper for drunks.
"Natural plant sources are meager at best in B12, and the vitamin is poorly absorbed from them. Many strict vegetarians and all vegans, as well as infants they breast-feed, must consume supplements or fortified breakfast cereals to get adequate amounts."
"In animal foods, B12 is combined with protein and must be released by stomach acid and an enzyme to be absorbed. Thus, chronic users of acid-suppressing drugs like Prilosec, Prevacid and Nexium, as well as ulcer medications like Pepcid and Tagamet, are at risk of developing a B12 deficiency and often require a daily B12 supplement.
Stomach acid levels decline with age. As many as 30 percent of older people may lack sufficient stomach acid to absorb adequate amounts of B12 from natural sources. Therefore, regular consumption of fortified foods or supplementation with 25 to 100 micrograms of B12 daily is recommended for people over 50."
243. Bug Killers
"In the 2010 trial, conducted on Grand Cayman island, researchers released 3.3 million male mosquitoes that had been genetically altered in such a way that they were born sterile, meaning they can't have viable offspring. They mated with females in a small test area and passed on the defect, which killed their progeny at the larval stage. That triggered a population collapse. 'We saw an 80% reduction in the target area" compared with the mosquito population in a similar zone where genetically tweaked males hadn't been released, Luke Alphey, co-founder and chief scientist at Oxitec Ltd., the U.K. start-up behind the experiment, said in an interview.' "Wall Street Journal,October 31, 2011
"Oxitec's target is dengue, a flu-like illness nicknamed "break-bone fever," whose incidence has soared in recent decades. The World Health Organization estimates there are 50 million infections annually. A rare, severe form can be fatal and accounts for some 25,000 deaths each year."
"The largely urban disease is transmitted by a striped mosquito known as aedes aegypti. Since there are no effective drugs against the malady, an alternative idea is to eventually release millions of genetically altered bugs to crash the wild population of aegypti and curb the spread of dengue."
The sterile mosquitos are not the only recent instance where scientists are using nature to fight nature. Kudzu, a tenacious Asian weed plant that covers the Southern United States, seems to have met is match. Megacopta cribraria, an insect native to Asia, has now entered the United States. Wall Street Journal, November 1, 2011.
"The bug, which has spread from North Carolina to Alabama, kills kudzu—a picturesque but pesky green vine that was itself an Asian import. Over the next decade, the bug could munch up to a third of the eight million acres of the kudzu that blankets the South, says James L. Hanula, an invasive plant specialist with the U.S. Forest Service in Athens, Ga."
However, the bug also attacks soybeans and has significantly reduced yields in fields it has infested. Agricultural scientists are looking for ways to bring it under control.
242. Hope for Malaria Vaccine
"The first vaccine against malaria has proved partially effective at protecting children, according to results published Tuesday…." Wall Street Journal, October 19, 2011, p. A4. "Three doses of the vaccine cut roughly in half the risk of developing malaria in children 5 months to 17 months old…." See New England Journal of Medicine, October 18, 2011. "The data from the vaccine, known as RTS,S/ASO1, are the first to be released from a clinical trial of 15,460 children at 11 test sites in seven African countries." More powerful vaccines are now in development.
241. Bee Well
We have written endlessly on the Global Province of the central place bees occupy in our health and welfare. For instance, “Try A Little Tenderness,” details just a few of the ways honey promotes human health. Now we learn that bee bites may just help battle cancer in “The Buzz: Targeting Cancer with Bee Venom,” Wall Street Journal, September 29,2009, p.D2. “Now the researchers have found a way, using…nanotechnology, to pinpoint tumors for attack by melittin while largely shielding healthy cells.” In fact, Washington University researchers are learning how to broadly use nanoparticles to deliver drugs to tumors, skipping healthy cells. “The nanobee technology has been licensed to Kereos Inc., a small biotechnology company founded by some of the Washington University researchers.
Fortunately bees are not about to disappear. Most recently there has been a glut of bees in California (Economist, March 7, 2009, pp.85-6. The UN is investigating an ostensible bee pollination crisis, but there is no clear data indicating that bee populations are really falling. (06-22-11)
Update: The Queen Bee; Eva Crane
While we have been at pains to portray how bound up the bee is with the health of Americans and American agriculture, we have been a bit slack on reporting on global bee science. For instance, “Eva Crane, who earned a doctorate in nuclear physics and then abandoned the field to devote herself to expanding and spreading knowledge about bees” was surely, during her life, the world’s major bee archdeaconess. See New York Times, September 16, 2007, p.25. “For more than a half-century Dr. Crane worked in more than 60 countries to learn more and more about honeybees, sometimes traveling by dugout canoe or dog sled to document the human use of bees from prehistoric times to the present. She found that ancient Babylonians used honey to preserve corpses, that bees were effectively used as military weapons by the Viet Cong, and that beekeepers in a remote corner of Pakistan use the same kind of hives found in excavations of ancient Greece.”
“Dr. Crane wrote some of the most important books on bees and apiculture, including “The World History of Beekeeping and Honey Hunting” (1999). In a review in The Guardian, the author Paul Theroux, himself a beekeeper, called the book a masterwork “for its enormous scope and exhaustiveness, for being an up-to-date treasure house of apiaristic facts.”
240. -new- Cure for AIDS
Timothy Brown of San Francisco had the AIDS virus until 4 years ago. Then living in Germany, he felt awful and discovered he had leukemia. “Brown was referred to Charité Medical University, where he was treated by Gero Hütter, a 37-year-old specialist in blood cancers.” Hutter, much to the chagrin of the professional AIDS directorate, decided to infuse his patient with delta 32 stems cells which “disables CCR5, a receptor on the surface of immune-system cells that, in the vast majority of cases, is HIV’s path inside.” Today Brown has no trace of the virus, an outcome quite different than that of retrovirals, which only control the disease. New York discusses his treatment in great detail. (06-22-11)
239. Sloth Kills or Why Never to Retire
“Over a lifetime, the unhealthful effects of sitting add up.” “The men in the study who spent six hours or more per day of their leisure time sitting had an overall death rate that was about 20 percent higher than the men who sat for three hour or less. The death rate for women who sat for more than six hours a day was about 40 percent higher.” Even aerobic exercise and less eating cannot counter the effects of sitting around too much. “What’s the Most Unhealthful Thing You Do Every Day?” New York Times Magazine, April 17, 2011, pp.39-41. (04-27-11)
238. Fighting Fire with Fire: Cancer to Beat Cancer
“Researchers at the Rogosin Institute are taking tumor cells from mice, encapsulating them in beads made from a seaweed-derived sugar called agarose, and implanting them in the abdomen of cancer patients. There, cells in the beads secrete proteins researchers believe could signal a patient’s cancer to stop growing, shrink or even die.” “Novel Effort to Fight Cancer with Cancer Cells,” Wall Street Journal, January 25, 2011, pp. D1&D4. The results really are not in from human trials, but the idea has worked out in mice, dogs, and cats. (3-2-2011)
237. Hot Spots: Cutting Costs Through Good Care
The New Yorker has many fine medical writers, mostly articulate doctors in Boston. This writing comprises its most distinguished coverage, and it is lucky to have a managing editor who is focused on healthcare. To read them, one would think Boston has superior across-the-board medical care, which is not the case. There you can find great medicine and also copious malpractice and neglect, as in most urban areas of the United States. The best writer is an ethically motivated doctor named Atul Gawande. Most recently he is renowned for The Checklist Manifesto: How to Get Things Right in which he theorizes that hospitals and other medical facilities could hugely cut medical error by simply having lists to follow in carrying out one protocol or another. Gawande focuses heavily on both medical costs and quality healthcare, thinking we might even have our cake and eat it, too. In his “Hot Spotters,” New Yorker, January 24, 2011, pp.40-51, he looks at a series of efforts around the country to use statistical analysis to spot the 10% of the population that accounts for 90% of a community’s medical costs. Usually we are talking about patients with co-morbidities or a series of related medical complaints who need steady, assisted coaching outside hospitals to stay functional and to unclog the arteries of hospitals. Chronic sufferers, in other words, need a kind of care that is not available in standard health systems. The cost of their care skyrockets because event-oriented medicine does not really deal well with ongoing medical conditions. In particular he focuses on Camden, New Jersey, one of the poorest, unhealthiest, and most crime-ridden city in the nation. Because of a physician named Jeffrey Brenner, who focused on places and people who generate huge costs, it might become “the first American community to lower its medical costs. We are reminded of Dr. Pekka Puska who started his vastly successful preventive health regime in North Karelia, the poorest region of Finland that had vastly higher incidences of heart disease and other fatal disorders. What we learn here is that in dealing with gruesome societal problems, it pays to focus on the worst cases, not the best, in trying to improve the workings of society. The article further hints that the cumulative practices of the healthcare system and of healthcare insurers actually exacerbate cost and health problems, rather than reducing them. (n.b., it used to be that in urban and business planning, one honed in on strengths, not weaknesses) (3-2-2011)
236. Understanding Your Medical Tests
The medical community surrounds itself in mystery. In part this is due to plain carelessness. But the docs and other healthcare experts very much enjoy euphemism, often hiding their uncertainty behind fancy words and copious, wordy nothingness. Wired, a magazine you should not buy because it is horribly designed and terribly hard to read, occasionally does a feature in plainspeak. We recommend “Blood Sample,” which tells you how to interpret test results that come in from the lab services. You should always demand lab copies of test results from your physician, not just your doctor’s vague interpretation. Here you learn to make sense of basic blood tests, heart disease indicators, and prostate information. The point of Wired’s article is to suggest how results can be better formatted: it’s a poor attempt at improving things on the part of notoriously inept Wired. But, in the process, the article highlights what you should be looking for amongst all the data. (12-15-10)
235. The Water Diet
“Drink a glass of water before meals and you will eat less.” Economist, August 28, 2010, p. 71. This is an old adage, but unproven up to now. Brenda Davy of Virginia Tech and a team of researchers have done randomized studies that confirm this idea. “After three months the group that drank water before meals had lost about 7kg (15½ lbs.) each whereas those in the thirsty group lost only 5kg. (11-10-10)
234. Health at Hixo
Mike Hicks is a witty graphic designer who hangs out in Austin, Texas. Probably his chortles are bad for business, since graphic designers are generally a tongue-tied, vapid lot. He has shared with us his prescription for healthy spirits:
“My best friend, Rick and I have lunch every week on Tuesday. Since we move in somewhat different social circles, our weekly lunch keeps us in contact. Over the last few years, he has become convinced he can contain the aging process with the proper combo of drugs, diet and exercise. He is wealthy enough to indulge in virtually every treatment, supplement, exercise regime, etc. that comes along. I hope he’s right, but I occasionally have to listen to him rant about observing a no fat, no starch diet while we are both wolfing down Spaghetti Bolognese. On top of this, he knows I work with a number of health related clients, including one that creates alternate, healthy school lunches. I spend hours each week analyzing nutrition and foods in the context of health issues. In spite of this and with some frequency, an e-mail will follow our lunch a day or two later filled with health tips. Below is the latest one (which only bears scanning) followed by my response:
Minimize these inflammatory aggravators in your diet to help promote optimal cardiovascular functioning.
1. *Saturated fats*. They can contribute to high cholesterol; avoid
whole-fat dairy foods such as cheese, cream and milk, as well as
2. *Trans-fats*. Found in most margarines, snack foods, heavily
processed foods and some cooking oils, these fats (often listed on
food labels as “hydrogenated” or “partially hydrogenated” oil) can
reduce HDL (“good”) cholesterol levels and raise LDL (“bad”)
3. *Animal protein*. Excessive animal protein has been shown to raise
levels of homocysteine, a toxic amino acid. Instead of animal
protein, try whole soy protein - aim for two servings of whole
soy, such as tofu or edamame, per day.
4. *Refined carbohydrates*. A diet full of cookies, cakes, crackers,
fluffy breads, chips and sodas can increase triglyceride levels
and lower HDL.
5. *Sodium*. Excessive sodium has been linked to high blood pressure
and heart disease. Avoid processed and canned foods, taste foods
before you salt them and do not add salt while cooking, avoid
foods that are visibly salted and read labels (aim for no more
than 1,500 mg sodium per day)
Minimize your exposure to and lower the quantity of toxins in your body.
To reduce your exposure:
* Do not smoke, and avoid secondhand smoke.
* Eat organically grown, pesticide-free foods whenever possible.
* Eat foods lower on the food chain.
* Do not ingest toxic or synthetic substances, including artificial
colors in foods.
* Avoid living or working near hazardous sites such as reclaimed
landfills or toxic waste dumps.
* Seek employment that does not involve contact with chemicals or
To reduce toxins that have accumulated in your body:
* Drink plenty of pure water.
* Have regular bowel movements - eating a diet with plenty of whole
grains and fresh, organic fruits and vegetables can promote
* Breathe clean air deeply.
* Sweat - a sauna, steam bath or vigorous exercise can help to
* Try milk thistle (/Silybum marianum/). This herb may have
beneficial, detoxifying effects, and supports optimal liver
function. Look for extracts standardized to 70-80 percent
silymarin, and take two capsules twice a day or as the label directs.
While I particularly relish a friend’s concern for my bowel movements and instructions on how to breathe, I couldn’t resist putting all his health hints into the context of what I assumed he must think was my life. Oddly enough, I haven’t received any more missives since.
I was finishing up another cigar after an exquisite meal of pork cracklings, batter fries and Twinkies when your missive arrived in my e-mail and made me start thinking. I recalled some wild milk thistle was growing just on the other side of the landfill that occupies the majority of my back yard and promptly decided to create a Thisthelian Thsalad, thslathered with my favorite bright orange French dressing. Noting your warning, I was careful to give the thistle leaves a thorough washing in Bestine to be certain none of the acids from the dump remained on them (one of the dogs dissolved after playing out there last week). They were a little tart, causing me to swoon and break out in a real tropical sweat, but with a few spoonfuls of salt and a little spray-on margarine, they didn’t taste half bad. I washed down the lingering after taste of acetone (not to mention a few thorns) with another Big Red. You were absolutely right. I have to admit I feel a lot better for having a really healthy meal and plan to encore the salad tonight with fried pork chops, a marriage of health and flavor. Hell, I think the salad would even be better topped with thin sliced rounds of Slim Jims (sort of a poor man’s prosciutto). Would that be too much meat? What do you think? I think it sounds delicious and thoroughly Mediterranean.
Most everything I eat is mentioned in your diet above, so I know I’m moving in the right direction. My only problem at this point is that these darn explosive bowel movements, which are regular but frequent, are eating the porcelain right off my toilet. Do you think the diet is causing these fiery, caustic discharges or should I look to other sources? I’ll admit I’ve been pretty stressed out lately as the 7-11 down the street is closing next month and I’ve grown used to walking to the store for groceries. Looks like I’m going to be getting some exercise come April, as the bus stop is down the road in the next block. The sheriff was pretty specific about me not driving after my last DUI, and the car is wrecked anyway, but being healthy is important so I’ll get there somehow.
Got to go and find some chips before NASCAR Week starts on the big screen. This is my last week of freedom as I have just accepted a position at ABC Pest Control. I’m looking forward to the challenge of steady employment and learning more about poison and bugs. Hope things are going well for you. I saw you at La Traviata, chowing down on a big plate of lasagna last week so I guess you’re getting into the health kick as well. Greasy Cheesy is what we call lasagna at my house. Damned that sounds good! I think I’ll go thaw one out right now.
Your pal, Mike
P.S. You mentioned it being hard for you to do the Stairmaster everyday, so I’ll let you in on my little secret: I installed a drink holder and ashtray on mine. Hell, as long as I can have a can of cherry vanilla diet coke and a ciggie, I’m prepared to climb that damned thing all day long. Try it!” (11-10-10)
233. Chef Lufthansa
Lufthansa has been experimenting to see how dryness and low pressure affect your taste buds. It crammed test subjects in the front of an Airbus “with shaker motors under each seat to simulate engine vibrations and pumps to lower the air pressure to 753 millibars at 15 percent humidity…..The pressurized cabin dulls our senses. Food tastes like it has 20 percent less sugar and salt than it actually does. To compensate, Lufthansa will boost the amount of sugar, herbs and spices in its meals, upgrade planes with humidifiers when possible, and pay more attention to aroma.” (Wired, November 2010, p.53). This illustrates what we intuitively know, and restaurateurs should better understand. At least 1/3 of dining quality is attributable to atmosphere. The meal tastes differently if the music is raucous, if the tables are too close to each other, if pesky waiters dart up and interrupt both the meal and the conversation. All sorts of physical conditions can play havoc with our taste buds. (10-26-10)
232. New Way to Attack Brain Cancer
“Designed to disrupt the division of cancer cells in the brain, the device –the “Novo TTF” (TTF stands for ‘tumor- treating fields’) delivers alternating electrical fields to the cancer cells by means of insulated electrodes on the surface of the scalp. The four electrodes, each covered with a bandage, are worn under a white cap.” “A New Way to Treat Brain Cancer?,” WSJ, June 8, 2010, p. D2. The device comes from Israel based NovoCure and is specifically designed for glioblastoma, a common and often devastating form of brain cancer. See American Society of Clinical Oncology abstract. (06-16-10)
231. Culture Vs. Alcoholism
“When confronted with the rowdy youth in the bar, we are happy to raise his drinking age, to tax his beer, to punish him if he drives under the influence, and to push hm into treatment if his habit becomes an addiction. But we are reluctant to provide him with a positive and constructive example of how to drink. The consequences of that failure are considerable, because, in the end, culture is a more powerful tool in dealing with drinking than medicine, economics, or the law.” Malcolm Gladwell, “Drinking Games,” The New Yorker, February 15 and 22, 2010, p.76. Certain groups, such as Italian first generation emigrants, who have cultural norms that govern their drinking, exhibit much less alcoholism than ethnic groups that do not share similar norms. Custom and culture achieve moderation, while laws and strictures eventually produce rebellion and lawlessness. (02-24-10)
Update: Why AA Works?
In “Secret of AA: After 75 Years, We Don’t Know How It Works,” Wired takes a look at Alcoholics Anonymous, restating some useful truisms, but not advancing our understanding of what alcoholism is all about. It clearly alludes to the group’s religious overtones, but does not grasp how that plays a part in its success. As Drew Pinsky remarks, “In my 20 years of treating addicts, I’ve never seen anything else that comes close to the 12 steps.” He is one of many experts who know that AA is really the only treatment that works, ministering to 1,000,000 alcoholics at any one time, but yet it only works for a small fraction of the alcohol-addicted population. As the writer notes, it is hard to tell why AA works: the writer gives most credence to theories that suggest that it is the power of the group and the intensity of close, positive relationships that make it transformational.
We think, however, that scientific investigators have learned a bit more than the writer discovered. In Glad well’s article, mentioned above, we learn that ethnic groups that drink a lot, yet follow a very prescribed regime, tend to avoid alcoholism. It’s possible that strong cultures with detailed mores that have a tight grip on its members can avoid alcoholism or can even reclaim those who have been caught in its web. The nature of our social and cultural environment, as much or more than our genetics, seems to determine our relationship to the bottle. (06-30-10)
230. The Genes of Success
“Of special interest to the team was a new interpretation of one of the most important and influential ideas in recent psychiatric and personality research: that certain variants of key behavioral genes (most of which affect either brain development or the processing of the brain’s chemical messengers) make people more vulnerable to certain mood, psychiatric, or personality disorders. Bolstered over the past 15 years by numerous studies, this hypothesis, often called the “stress diathesis” or “genetic vulnerability” model, has come to saturate psychiatry and behavioral science. During that time, researchers have identified a dozen-odd gene variants that can increase a person’s susceptibility to depression, anxiety, attention-deficit hyperactivity disorder, heightened risk-taking, and antisocial, sociopathic, or violent behaviors, and other problems—if, and only if, the person carrying the variant suffers a traumatic or stressful childhood or faces particularly trying experiences later in life.”
“Recently, however, an alternate hypothesis has emerged from this one and is turning it inside out. This new model suggests that it’s a mistake to understand these “risk” genes only as liabilities. Yes, this new thinking goes, these bad genes can create dysfunction in unfavorable contexts—but they can also enhance function in favorable contexts. The genetic sensitivities to negative experience that the vulnerability hypothesis has identified, it follows, are just the downside of a bigger phenomenon: a heightened genetic sensitivity to all experience.”
“Though this hypothesis is new to modern biological psychiatry, it can be found in folk wisdom, as the University of Arizona developmental psychologist Bruce Ellis and the University of British Columbia developmental pediatrician W. Thomas Boyce pointed out last year in the journal Current Directions in Psychological Science. The Swedes, Ellis and Boyce noted in an essay titled “Biological Sensitivity to Context,” have long spoken of “dandelion” children. These dandelion children—equivalent to our “normal” or “healthy” children, with “resilient” genes—do pretty well almost anywhere, whether raised in the equivalent of a sidewalk crack or a well-tended garden. Ellis and Boyce offer that there are also “orchid” children, who will wilt if ignored or maltreated but bloom spectacularly with greenhouse care” In other words, those equipped with certain types of genes will shrivel in the wrong circumstance, but will flourish in the right hothouse. See Atlantic, December 2009. See “Biological Sensitivty to Context” abstract. (12-9-09)
229. Cellphones and Brain Cancer
In “Fact or Fiction?: Cellphones Can Cause Brain Cancer,” Scientific American offers a balanced view of this controversial matter, a reasoned fairness that has been missing from many other testty questions, such as global warming. The jury is still out. On the one hand, it makes clear that most of the heavy hitters would say there’s nothing in it and that it would be more or less impossible for cellphone exposure to produce cancer. On the other, it notes worrying preliminary studies in Sweden where its younger population has a much longer history of high cellphone use, and enough cancer to matter is showing up in youngsters.
“Cell phones use non-ionizing radiation, which differs from the ionizing radiation of x-rays and radioactive material in that it does not have enough energy to knock around—or ionize—electrons or particles in atoms. Cell phone radiation falls into the same band of nonionizing radio frequency as microwaves used to heat or cook food. But Jorn Olsen, chair of epidemiology at the University of California, Los Angeles, School of Public Health says that unlike microwaves, cell phones do not release enough radiation or energy to damage DNA or genetic material, which can lead to cancer.”
“Recent research suggests, however, that although short-term exposure is harmless, long-term cell phone use may be a different story. Three studies since 1999 indicate that people who have used cell phones for more than a decade may have as much as three times greater risk of developing brain tumors on the side of the head against which they most often hold their phone—an argument for, at the least, shifting ears regularly or, even better, using an earpiece or the speakerphone feature while chatting.” Incidentally, our science establishment, as opposed to the Russians, showed similar shortsightedness in relation to microwaves. The paid attention to the waves that had short-term effects, but not to the spectrum that took a long time to do its worst—the time bomb part of the microwave dilemma.
The article does not do a very good job of suggesting what a cautious person might do, especially what parents might do for their cell-addicted children. One needs some sort of wired earphone that plugs in to the cellphone (not wireless earphones) to keep the waves at bay. Also one would be well served not to carry the phone at the beltline, unless one has a very insulated pouch. Good wired earphones that plug into cells and such pouches are hard to come by, however. (11-25-09)
Update: Cell phone Warnings
Government officials, dogmatic scientists, and industry apologists keep sweeping cell phone detritus under the rug, but it just won’t stay buried. Legislators in Maine and in a few other places are trying to have warnings put on cell phones, indicating that they may be hazardous to one’s health. Sort of a cigarette warning. Some fairly serious people have come out with an intriguing rogue report that sounds more alarms about cell phone radiation. On the one hand, the radiation emitted does not seem sufficient to produce cancer directly—a fact many scientists harp on. On the other, we are beginning to understand that we don’t really understand the complexities of how cancer is produced, and it is plausible that surrounding tissues in the brain are altered gradually in ways not well understood and that they eventually serve as a catalyst for dormant cancer cells. We do know, for instance, that short-term and long-term human afflictions are produced by different parts of the microwave spectrum, although we have tended only to study short-term effects in the United States.
The nickel in cell phones sold in the United States poses a lesser health worry. The Wall Street Journalreports, “Nickel is even used in some cellphones and has been known to cause irritations on users' ears and faces—a phenomenon dubbed "mobile-phone dermatitis." In a study published last year in the Canadian Medical Association Journal, researchers at Brown University tested 22 mobile-phone models and found nickel in 10 of them, mostly on menu buttons and company logos. To cut down on allergic reactions, the European Union severely restricted the use of nickel in jewelry in 2001 and cellphones last year.” (01-06-10)
Update: Brain Waves and Other Currents
“A new study by Yale neurobiologists David McCormick and Flavio Fröhlich” shows that electrical currents in the brain work to coordinate brain functions and “to synchronize neural circuit activity.” Yale Alumni Magazine, September-October 2010, p. 31. “This finding may explain why therapies that use electrical fields can be effective treatments for depression, schizophrenia, tremor,” and other patterns. “But the study also suggests that everyday electrical fields could also influence brain activity. McCormick worries about the possible untoward effects of such devices as cell phones and power lines, though he has not yet studied their effects.” (09-15-10)
Update: Mistake in YAM
Readers should be aware that the Yale Alumni Magazine writer appears to have misread the McCormick study cited above. That is, the researchers were referring to endogenous influences, not external currents, in their study. So they were, in fact, not making any claims about power lines and the like. That is still an entirely different question. (09-29-10)
Update: Cell phones: No Effect: Well, Harmless Anyway
Update: Most of the scientific community is cocksure that there is no connection between cell phones and brain cancer. They provide long-winded explanations as to why cell phones could not fry the brain enough to produce a cancerous effect. One reliable skeptic, for instance, is Robert Park, a Maryland academic, who cites the numerous studies that suggest no connection whatsoever. Of course, little disturbing dribbles continue to trickle in that throw up a caution light. A recent study, for instance, does show that prolonged conversations on the phone do scramble up the brain a bit, right near where the cell phone meets the head. Dr. Volkow, the very careful scientist who headed up the study, makes absolutely clear that she would make no claims as to whether the noted effects were either benign or hurtful. Leave that to physical scientists such as Park who say the effect is minor league, to be expected, and harmless. A more careful scientist would say that we simply do not know the effect of very minor wave dosages over a number of years, although it is clear that the effects would appear to be nil short term for minor dosage(s).
The problem, of course, is that much of our scientific community is over-wedded to the idea that technology is an unadulterated benefit to mankind, so that scientists have a tough time looking at technical phenomena with a gimlet eye. . In the back of our heads lurks the memory of microwave devices: it took years for technologists to come to terms with certain parts of the wave spectrum and insulate consumers against them. To the best of our knowledge, consumers still are not protected against other parts of the spectrum. In fact, our scientists in this country have not even looked at such effects, though those in other countries, particularly Russia, have done so. In fact, the Russians, at least during the Soviet period, trained microwave devices on Western embassies in other to pick up certain intelligence: they did cause some health problems.
There is no clear evidence that cell phones cause health problems, and this must be stated flat out. But the painstaking scientist would be foolish to rule out the possibility that all might not be right with these devices.
Then again, one can avoid the whole problem by simply casting cell phones aside. Wayne Barrett, a crack investigative reporter, won’t have anything to do with them. “Mr. Barrett refuses to use a cell phone, insisting that people are not meant to always be in contact with one another; he is more animated and long-winded about this pet peeve than about any of the political corruption he has covered. “ (See “The Digging for Dirt Hasn’t Stopped,” New York Times, February 27, 2011, p. 27. (3-2-2011)
228. Contagious: The Network Effect
Any imaginative CEO of any kind of business or institution should read “Is Happiness Catching,” New York Times Magazine, September 13, 2009, pp.28-35, 42, & 57. It’s a simple notion really. An awful lot of what we do and even feel comes about because our friend does it, who does it because another friend does it. The Times calls it “a look inside the emerging science of social contagion.” Some people talk disparagingly of the “herd mentality.” But, in fact, most of us are sheep or cows, waiting to be herded. Investors in the big cities march into the same bad choices in lockstep, simply because they are next to each other. But it’s possible to turn this domino theory to good effect—to get enough people aligned behind civility that we overcome the vitriol, polarization, and swamp behavior peddled by cable TV, fringe groups, and pathological people not kept in check. This particular article is based on the work of Nicholas Christakis and James Fowler who tapped into the database of the ongoing Framingham Study to achieve some understanding of network effects in small communities. They have published their conclusions in a raft of publications, including The New England Journal of Medicine, The British Medical Journal, The Journal of Health Economics, starting in 2007. What this means is that we cannot conquer certain entrenched health problems—smoking, obesity, etc.—if society at large is dedicated to unhealthy behaviors. All our healthcare reforms are for nought unless we can first migrate to a healthy society. Likewise, companies that want to introduce a pathfinding product or service need to infect society with new notions, or they will have disappointing results. (10-28-09)
227. Cautions on Genome Research
“David Goldstein of Duke University, a leading young population geneticist known partly for his research into the genetic roots of Jewish ancestry, says the effort to nail down the genetics of most common diseases is not working.” He says, “After doing comprehensive studies for common diseases, we can explain only a few percent of the genetic component of most of these traits….For schizophrenia and bipolar disorder we get almost nothing; for Type 2 diabetes, 20 variants, but they explain only 2 to 3 percent of familial clustering, and so on.”” (“A Dissenting Voice as the Genome Is Sifted to Fight Disease,” New York Times, September 16, 2008, p.D3. “What has happened is that a multitude of rare variants lie at the root of most common diseases….” (10-28-09)
226. Eczema and Asthma
Asthma is a disease of the richer, developer countries, almost absent in poor nations. “The direct cause is a chemical distress signal produced in skin that is damaged by another hazard of modern life: eczema.” Eczema, though not harmful in itself, is on the rise in the West: “17% of children in America have it, and similarly high figures are found in Australia, Britain and New Zealand.” In American 70% of eczema sufferers will get asthma. “The culprit is thymic stromal lymphopotetin (TSLP), a signalling molecule secreted damaged skin cells….” Steroids, rarely used, would be the best way to treat the eczema. One suspect might be detergents. See “Breathe Easy,” Economist, 23 May 2009, p.85. See also “Skin-Derived TSLP Triggers Progression from Epidermal-Barrier Defects to Asthma.” (09-09-09)
225. Cutting the Fat
In “Taking 30 Pounds Off America,” we found that losing weight is an infinitely complex process where individual willpower only goes so far, which hardly gets us down the field. Fatness is, in the end, just one symptom of an unhealthy, addictive society where many things have to be re-aligned if the nation is going to lose weight. So we will be compiling all sorts of insights about obesity and weight loss here as they arise:
“Thinking makes you hungry, and thinking really hard makes you really hungry.” The Week, September 26, 2008, p. 21. Students at Laval University were given tasks that required varying amounts of thought: those with heavy-think tasks ate a lot; those with easy tasks just nibbled. See “Glycemic Instability and Spontaneous Energy Intake: Association With Knowledge-Based Work”
“The cost of treating obesity doubled over a decade,” and “may have soared as high as $147 billion in 2008, the Centers for Disease Control and Prevention said….” “Cost of Treating Obesity Soars,” Wall Street Journal, July 28, 2009, p. D3. “Obese people spent 42% more than people of normal weight on medical costs in 2006….” “In his speech Monday, Dr. Frieden said measures that had worked to control tobacco, such as taxes and reduced exposure, could help reduce obesity, too.” Formerly New York City’s Health Commissioner, Thomas Frieden now heads the CDC.
“The reasons behind the leveling off in childhood obesity in the United States, Australia, France, Switzerland, Sweden and New Zealand remain shrouded in mystery.” Wall Street Journal, July 22, 2009, p. A11. This is in stark contrast to the 90s when children’s waistlines seemed to be swelling uncontrollably.
“Kelly D. Brownell, a psychologist at Yale, says that when trying to lose weight, motivation matters most.” “For a Frugal Dieter, Weight Loss on a Sliding Scale,” New York Times, July 4, 2009, p. B6. “ “Keeping weight off permanently is a lifelong process,” says James O. Hill, a psychologist and a founder of the National Weigh Control Registry (www.ncwr.ws), a database of 6,000 people who have lost weight and kept it off.” (08-12-09)
for Bees: Bee Plaque
For several years now an
illness has been afoot that has devastated bee colonies. “Researchers are scrambling to find
the cause of the ailment, called Colony Collapse Disorder.” (Associated
Press, February 12, 2007). “Reports of unusual colony deaths have come
from at least 22 states. Some affected commercial beekeepers — who often
keep thousands of colonies — have reported losing more than 50 percent of
their bees. A colony can have roughly 20,000 bees in the winter, and up to
60,000 in the summer.” “Scientists
at Penn State, the University of Montana and the U.S. Department of Agriculture
are among the quickly growing group of researchers and industry officials
trying to solve the mystery” “Cox-Foster said an analysis of dissected
bees turned up an alarmingly high number of foreign fungi, bacteria and other
organisms and weakened immune systems.”
be noted, however, that waves of disease have periodically stricken bee
populations since colonial times. It is possible this is just another one of those serious but predictable
outbreaks. Beekeepers lost 37% of their hives in 2008, and 31% in 2007. “Enter Beeologics, a Miami Biotech startup that
aims to create vaccines for all viruses that could lead to CCD.” Fortune Small Business, March 2009,
p.27. “Ilan Sela, 71, an Israeli
expert on sequencing the genome of bee viruses” is involved. “Jeff Pettis, head
of the USDA’s
Bee Research Laboratory, is cautiously enthusiastic about Remebee’s
potential.” This is their first
vaccine to be sold at $2 a does in summer 2009.
Update: Better Bees
Marla Spivak of the University of Minnesota has “bred a strain of pollinating bee that fights varroa, a parasite linked to widespread bee deaths. “With colony losses fluctuating around 30 to 40 percent every year,” scientists and agriculturists are desperate to find a solution. “These days, breeders are using her freeze-kill method to rear hygienic strains” of bees. “Spivak today concentrates on an antimicrobial resin called propolis that wild bees shellac onto the inside of their hives as a sort of collective immune system—maybe pointing the way to an even better bee.” (Wired, March 2011, p.117.) (04-27-11)
223. Cancer: Get It Way Early with Statistics
“The US spends billions of dollars to save these late-stage patients, trying to devise better drugs and chemotherapies that might kill a cancer at its strongest. This cure-driven approach has dominated the research since Richard Nixon declared war on the disease in 1971. But it has yielded meager results: The overall cancer mortality rate in the US has fallen by a scant 8 percent since 1975. (Heart disease deaths, by comparison, have dropped by nearly 60 percent in that period.) We are so consumed by the quest to save the 566,000 that we overlook the far more staggering statistic at the other side of the survival curve: More than a third of all Americans—some 120 million people—will be diagnosed with cancer sometime in their lives. Their illness may be invisible now, but it's out there. And that presents a great, and largely unexamined, opportunity: Find and treat their cancers early and that 566,000 figure will shrink.” Wired, “Why Early Detection Is the Best Way to Beat Cancer,” December 22, 2008. “This new approach treats diagnosis as an algorithm, a sequence of calculations that can detect or predict cancer years before it betrays symptoms. It starts with a statistical screening to identify people, like Rosenthal, who have a genetically greater risk for disease. A regular blood test follows, one primed to look for telltale proteins, or biomarkers, correlated to specific cancers. A positive result prompts an imaging test to eliminate false positives or isolate a tumor. The process is methodical, mathematical, and much more likely to find cancer than current diagnostic procedures.” “In 2004, he (Listwin) created the Canary Foundation, a research group with the single goal of bringing a battery of screening tests to patients and their doctors by 2015, starting with ovarian cancer and moving on to pancreatic, lung, and prostate. Listwin likes to explain the Canary approach with PowerPoint, and every presentation starts with a slide of the survival curve for cancer. Pointing to the 90 percent, he makes this simple observation: When we see cancer early, we have a chance to fight it.”
Quite a body of research is growing up in which mathematics is being put to work on cancer detection. See “Can Math Cure Cancer?” Forbes, October 27, 2008, pp.74-76. Kristin Rae Swanson of the Unversity of Washington has “created a software program that uses data from magnetic resonance imaging scans to simulate how fast a patient’s brain tumor is likely to spread.” “Swanson’s” equation “bears a certain resemblance to the Fourier heat equation.” (03-04-09)
“A new type of eatery called a ‘doctor’s restaurant’ … is becoming
popular in Japan. Such restaurants provide menus that have been
certified by physicians from a medical standpoint” (Trends In Japan, 8
August 2008). “One such establishment is Tokyo Food Theater 5+1,
located in Tokyo’s Akihabara district. Medical specialists were
involved in planning this restaurant’s menu. The ‘anti-aging and
beautiful skin’ course, for example, was developed under the
supervision of Professor Shirasawa Takuji, who teaches a course on
anti-aging medicine at Juntendo University, Graduate School of
Medicine.” “Osaka, meanwhile, is home to a restaurant called
Chishoku Shunsai ETSU, whose cuisine is designed specifically to be
safe and healthy for people with diabetes.” “Mikuni Minceur is
located inside the Yotsuya Medical Cube in Tokyo’s Yotsuya district,
and it serves mainly French food under the concept of providing
customers with ‘beautiful, delicious, and healthy cuisine.’ This
restaurant's cuisine minceur features a variety of tastes contained
within low-fat foods.” (11/5/08)
221. Getting Water
A goodly portion of the world’s population does not have
access to germ-free water. Huge problems ensue for people in
underdeveloped nations. Mikkel Vestergaard of Denmark, who spent
a goodly amount of time in Nigeria, has, as a result, devised the
LifeStraw, “a personal, portable water purifier that eliminates
virtually all waterborne bacteria and most viruses responsible for
causing diarrheal diseases.” Today he heads a family firm in
Lausanne, Switzerland, Vestergaard
Frandsen, which makes the LifeStraw. It uses textile and
iodine filters, and carbon to sift out the taste of iodine.
Founded as a maker of work clothing, it shifted into 1992 to relief-aid
products. It also manufactures PermaNet, an insecticide treated
mosquito net. (9/24/08)
220. Health Phone
Along comes Voxiva in Washington,
D.C. Paul Meyer, its chairman, has a “long history of pulling off
projects in challenging locations: Albania, Guinea, India” (Forbes,
June 30, 2008, pp. 58-60). “Meyer created a communications system
that works on any telephone network and can be accessed on any mobile
handset, PC or landline phone using voice messages, e-mail or SMS
text.” “Last year the company grew 58% and was cash flow positive
in the fourth quarter. Today Voxiva has 120 employees, clients in
15 countries, and 60 projects underway.” (9/10/08)
Everybody makes a big deal out of all the schemes to
deliver us better health over the Internet, ranging from patient
information records to sundry ways of providing information about
diseases and sundry health conditions. The trouble is that most
of them are created by and designed for health nerds who are earning
their living in the health business. They’re not for
patients. In fact, the telephone is the best device for dealing
with live patients and helping them out, since the sickest are elderly
and not inclined to use computers.
219. Hospital Towns
“What happens when a clinic takes over a metropolis?” (Economist,
February 23, 2008, p.44). “A select few cities have entered the
era of the mega-hospital. The most dramatic are Rochester, a
medium-sized city where Mayo has long been a star business, and
Cleveland, Ohio, a rustbelt city that has seen its hospitals boom and
one, the Cleveland Clinic, become a new economic force. Each
hospital is a behemoth: Mayo’s revenues in 2006 totalled $6.3
billion, Cleveland’s $4.4 billion.” “The Cleveland Clinic is America’s
best heart hospital; Mayo tops the rankings for neurology, digestive
disorders and endocrinology.” Their systems are huge, and their main
campuses are larger than the Pentagon. “Cleveland’s 37,350
employees make it Ohio’s second-largest private employer in 2006, after
Wal-Mart. Mayo is Minnesota’s biggest private employer.”
Both have become big destinations for health tourists. Both have
branched out in various ways to other locales, expanding their
revenues. However, this article really does not evaluate what
happens to the community when it is host to a health colossus. We
do not even know if it has a positive, neutral, or negative effect on
the city’s health. (7/30/08)
218. Cortisol and Chronic
“The researchers, writing online in The Journal of Clinical
Endocrinology and Metabolism, said the low levels of the hormone,
cortisol, might play a role in the severe fatigue found in many
patients with the syndrome” (New York Times, January 29, 2008,
p. D6). “We were surprised that the effect was limited to women,”
Dr. Reeves said in an email message, “and this may help to explain the
higher prevalence of C.F.S. in women.” We suspect the cortisol
variation is a symptom of the disease condition, rather than a
causative factor. Nonetheless, it is still heartening to get any
faint hint as to what goes on with this elusive disease. See
“Attenuated Morning Salivary Cortisol Concentrations in a
Population-based Study of Persons with Chronic Fatigue Syndrome and
Well Controls” (JCEM, December 26, 2007). (4/16/08)
Update: Roots of Chronic Fatigue
Scientists have new hunches as to the origins of chronic fatigue
syndrome or myalgic encephalomyelitis (ME). It may have its roots
in genetics. ME Research
UK and Irish ME Trust had a recent
meeting where new findings emerged. Jonathan Kerr of St.
George’s University in London said he and his colleagues have
identified 35 genes that are expressed differently in CFS
sufferers. Julia Newton of Newcastle University found that the
automatic nervous system may be askew in many acute sufferers: those
taking exercise suffer from acid build-up in the muscles. It’s
thought that drugs that help maintain blood flow could make up for the
erratic nervous systems. There is some thought that CFS may come
at the tail end of a period of infectious disease in those with a
predisposition to such fatigue. (10/8/08)
Update: CFS Virus? A study published in Science suggests a linkage between a retrovirus and chronic fatigue syndrome. See “Detection of an Infectious Retrovirus, XMRV, in Blood Cells of Patients with Chronic Fatigue Syndrome,” Science, October 8, 2009. “Thousands of patients have already contacted scientists, asking to be tested, said Dr. Judy Mikovits, the first author of the study and the research director at the Whittemore Peterson Institute in Reno, a research center created by the parents of a woman who has the syndrome.” New York Times, October 13, 2009, ppD1-D2. “The new suspect is a xenotropic murine leukemia virus-related virus, or XMRV….” It has been detected in ¼ of men with prostate cancer as well, and comes from the virus family that causes AIDS and leukemia.
“An estimated 17 million people world-wide suffer from chronic fatigue syndrome, and the Centers for Disease Control and Prevention puts the U.S. figure at between one million and four million.” Wall Street Journal, Ocotber 9, 2009, p.A3. Retroviruses stay residually in the body permanently, once a person is infected. “Dr. Mikovitz said they also found XMRV in people with autism, atypical multiple sclerosis, and fibromyalgia.”
Hillary Johnson, who has written a book about CFS called Osler’s Web and maintains a website about it, usefully commented on this new discovery in the New York Times. She notes that the medical establishment, inside and outside of government, has ignored this disease for decades. Once again, onerous diseases that affect millions (but not tens of millions) are moving towards resolution because of dynamic advocates from outside the medical sector such as Ms. Johnson and the Whittemores. (11-11-09)
Update: The Jury’s Still out on CFS
Two groups of researchers are at odds as to whether a virus called XMRV if linked to chronic fatigue syndrome. Scientists at the Food and Drug Adminstration concluded that the virus is found in the blood of CFS sufferers. “Separately, scientists at the CDC, led by microbiologist William Switzer, concluded in a paper in another journal, Retrovirology, concluded” that they could not find it in the blood of CFS patients. Such a conflict is not unusual, as scientists struggle with discoveries in a new frontier. We note, however, that we have talked with some sufferers who have been tested and found positive for certain viruses and retroviruses: they report some success with the use of alternative treatments in the herbal domain where anecdotal evidence is somewhat positive. We suspect, for the first time, that scientists are pointed in the right direction, even though much more must be understood about the viral mechanism. See Wall Street Journal, June 30, 2010, p. A7. (08-04-10)
Update: Jamie and Her Daughter
On August 24, 2010, the WSJ published a front-page headline story “New Hope in Fatigue Fight.” If the truth be told, it was simply rehashing old news. Researchers are circling viruses and retroviruses, believing that some viral combination accounts for at least the bulk of CFS. But there’s one little gem. The article makes reference to Mrs. Jamie Deckoff-Jones, a Santa Fe doctor and CFS suffer whose daughter is also afflicted. “Both tested positive for XMRV and are taking a combination of three anti-retrovirals.”
“Dr. Deckoff-Jones said a year ago she could only get up for short periods during the day. After five months on the drugs, she flew last week to Reno for an XMRV conference. Her daughter was able to go to a party and is enrolling in community college. "This is all very new, and there is no way to know if improvement will continue,'' Dr. Deckoff-Jones wrote in an email, "but we appear to be on an uphill course.''” Dr. Deckoff-Jones maintains a blog which all should read, since doctors who have a disease and are working on its cure are very good resouces. It is called X RX.
Those interested in the initial research in Reno which pointed to the role of retroviruses should view a series of videos that record the October 2009 of Dan Peterson before the CFSAC in Washington D.C. (09-15-10)
Update: The Long History of CFS
Useful bits and pieces continue to drift in about CFS. More and more patients with whom we talk do turn out, after testing, to have one virus or retrovirus or another. We suspect that more than one viral agent may be at work here. Standard pharmacology seems to have little to offer, but offbeat alternative remedies often do have an effect. For instance, a West Coast physician, uncovering viruses at work in one patient, has offered a useful battery of plant and herbal substances, shitake mushrooms being one. This sufferer has been able to double her active daily hours.
It’s a bit disturbing to read “The Puzzle of Chronic Fatigue,” Wall Street Journal, March 5-6, 2011, pp.C1-2. We learn that Dr. David Bell in Lyndonville, New York has been treating a persistent CFS local outbreak since 1985. Even though he sent blood samples to the CDC, it could uncover nothing. “In 1989, Dr. Bell sent blood samples of his Lyndonville patients to an immunologist named Elaine DeFreitas at the Wistar Institute in Philadelphia. She found evidence of a retrovirus in the blood of two-thirds of 30 pediatric and adult patients diagnosed with chronic fatigue syndrome.” See Dr. David Bell’s Lyndonville News website which provides useful links, listing of his books, and other useful data. What’s bothersome here is that the retrovirus theory has been around quite a while, but it has not been usefully pursued by the government and well-funded academics.
Though we ourselves do believe that CFS stems from an organic affliction of the body—some sort of viral composite—it is nonetheless useful to understand that both exercise and psychological help may provide modest relief. A study published in Lancetsuggests as much. However, the amelioration such treatment affords cannot pretend to be revealing about the origins of the disease. (3-29-11)
Update: Ampligen Reviewed for CFS
"A potential treatment for chronic fatigue syndrome gets a new look this week with a federal advisory panel review of Hemispherx Biopharma Inc.'s HEB 0.00%experimental drug Ampligen.
The drug, in development for chronic fatigue syndrome for about two decades, and the Philadelphia-based firm have faced setbacks. In 2009, the U.S. Food and Drug Administration refused to approve Ampligen, saying clinical studies submitted for approval of the product didn't provide "credible evidence" of the drug's effectiveness" WSJ, December 17, 2012, P.B2. Subsequently the panel turned thumbs down on Ampligen. Interestingly certain parts of the CFS community are so energized that there has been a protest over the Government Action. See also FDA response to the vociferous outburst over its denial. (April 24, 2013)
Update: CFS Drug
Ampligen continues its on again, off again attempts at approval by the FDA, while other candidates report varying degrees of success, such Roche’s Valcyte and Genentech—Biogen’s Rituxan, all experiencing patchy success and facing skepticism from federal panels. See “Drug for Fatigue to Get Fresh Look,” and “FDA Turns Down Chronic Fatigue Drug,” where we learn that regulators want more clinical work before considering approval of Ampligen. (6-12-13)
Garlic, it seems, stimulates the body’s generation of
hydrogen sulfide—and that turns out to be a good thing. See
“Unlocking the Benefits of Garlic, “ New York Times, October
15, 2007. “In the latest study, performed at the University of
Alabama at Birmingham, researchers extracted juice from supermarket
garlic and added small amounts to human red blood cells. The
cells immediately began emitting hydrogen sulfide, the scientists
found. The power to boost hydrogen sulfide production may help
explain why a garlic-rich diet appears to protect against various
cancers, including breast, prostate and colon cancer, say the study
authors. Higher hydrogen sulfide might also protect the heart,
according to other experts.” As it turns out, one needs to eat 5
to 8 cloves a day to get a bang. Further, one should let the
garlic sit 15 minutes after crushing, before using it in cooking.
Pressure: Containing the Gorge
Another instance where we don’t know which is the
chicken and which is the egg. People with lower blood pressure
are happier, and visa versa, but who knows what causes what.
“Researchers at the University of Warwick have found a direct
connection between a nation’s overall happiness and its citizens’ blood
pressure problems. Sweden, Denmark and the UK come top of this
blood pressure based happiness league while Germany, Portugal and
Finland come bottom.” “Happy countries have fewer blood-pressure
problems. Mental health in each country, they show, is also
inversely correlated with its rate of hypertension. The study
ranks countries in this order: Sweden, Denmark, UK, Netherlands,
Ireland, France, Luxembourg, Spain, Greece, Italy, Belgium, Austria,
Finland, Germany, Portugal” (Press Release, University of Warwick, 18
Feb. 2007). (1/30/08)
As in many things, healthcare innovation appears to be taking place
outside the main developed nations (U.S., Germany, Japan, etc.).
We have previously pointed to Finland
as the country that has shown the most dramatic gains from activist
public health measures. (11/28/07)
The Dutch have come up with a scheme where everybody gets
health insurance, but private health insurance carriers provide the
coverage. See “In Holland, Some See New Model for U.S.
Health-Care System,” Wall Street Journal, September 6, 2007,
pp. A1 and A14. “Since a new system took effect here last year,
cost growth is projected to fall this year to abot 3% after inflation
from 4.5% in 2006. Waiting lists are shrinking, and private
health insurers are coming up with innovative ways to care for the
sick.” Everybody gets health insurance; insurers must
accept everybody who applied; the government provides aid to those who
cannot afford premiums through a tax on the rich. Menzi’s
has opened primary care centers of its own to lower costs; UVIT gives
discount vouchers to those using low cholesterol dairy products and
offers other incentives for consumers leading healthy lives. This
is along the lines of Alain Enthoven’s managed
competition. The government also provides ‘risk equalization’
payments to companies for taking on the elderly and chronic patients
with certain conditions. The changeover has apparently gone rather
smoothly with premiums lower than predicted. Generic drug prices
have also come down due to negotiations by the government. The
insurers, however, have had some profit difficulties, and it remains to
be seen whether they can get hospitals to cut costs to help shrink
“Right now, Akonni’s reader is about the size of a Nintendo Wii
console. Daitch is producing a prototype for a handheld device
that looks very much like an iPod. But making it work is a
challenge more worthy of the iPhone—cramming three functions onto one
tidy package” (Wired,
July 24, 2007). (11/14/07)
Akonni Biosystems in
Maryland is working on a gadget that will test for everything on the
cheap. It will look for every kind of infection, and it won’t
cost an arm and a leg as does the present battery of tests for
diseases. “Daitch calls his tool TruDiagnosis. It combines
advances in microfluidics (miniaturized pumps and channels),
microarrays (micron-sized sensors affixed to a chip), and engineering
into what could be the ultimate medical gadget: a handheld device that,
using a small sample of blood or spit, reveals in mere minutes every
pathogen inside the body. It would work in hospitals, in labs, in
the field, perhaps even in homes. TruDiagnosis is Akonni’s twist
on so-called molecular diagnostics, the promising discipline that
detects the presence of a bacteria or virus when only a few molecules
of DNA, protein, or other biomarkers are present.” “Akonni … is
going low-cost, high-volume. The TruDiagnosis system has two
parts: the credit card sized array, which can be tailored to detect
combinations of diseases or strains of a particular disease, and the
device that processes and reads the array.”
By and large, the results with botanicals have been spotty. “One
company that is aiming to beat the odds is Phynova, a small British
drug-research concern that has the green light from the FDA to test a
hepatitis botanical drug. The drug is a combination of four
different plants: the roots of the astragalus and the Chinese salvia
plants, the fruit of the schisandra plant, and milk thistle. The
hope is that they will all work synergistically to combat the symptoms
of chronic hepatitis.” We had a doctor in the Far East look over
the ingredients; he replies: “Good combo, probably with the latter two
ingredients best.” (10/31/07)
The FDA, for the first time, is looking at botanical drugs in a serious
way. “Some 250 botanical drugs have … been cleared to proceed to
clinical trials. See “Dueling Therapies: Is a shotgun better than
a silver bullet?” Wall Street Journal, March 2, 2007, p.
B1. On the Global Province we include an essay from one noted
Arm for the First World”—suggesting to the FDA that botanical
alternatives be included in all drug trials, since the vast majority of
manufactured drugs show such an array of side effects. At least
the FDA has opened the door to useful botanical trials.
“Average lifespan has increased 30 years over the past century—mostly
due to commercially developed vaccines,” says Paul Offit, chief of
infectious diseases at Children’s Hospital in Philadelphia (“Sick
Propaganda,” Wall Street Journal, July 13, 2007, p. A13).
Nine vaccines—“which save about eight million lives a year”—were made
by Maurice Hilleman
of Merck. Offit is right about vaccines, of course, which he uses
to put down Michael Moore’s Sicko, which castigates the
pharmaceuticals. Unfortunately it’s a false argument. The
pharmaceuticals and the healthcare system are peddling treatments
galore that are useless or worse, with responsible estimates suggesting
that 1/3 of healthcare procedures simply should not be done. As Moore
makes clear, this is wasteful and horribly expensive. Vaccines
and preventive care, which the hopeless Moore does not dwell on, must
become the order of the day. (9/19/07)
Training Rural Doctors
Mile, the fee for three years of classes is 3,400 yuan (about $448),
plus 400 yuan for books. Haoyisheng receives about 1,200 yuan per
student from the government. The company, which has training
programs in urban areas as well as short-term courses on topics such as
emergency medicine, says it had a profit of $1 million last year on
revenue of $9 million.” (9/12/07)
“Now, a company called Haoyisheng.com Inc. … has set up outlets in
remote villages and small cities like Mile (pronounced Meel-eh), where
local doctors attend video classes in essential matters of diagnosis
and care. So far, Haoyisheng.com has outfitted 6,000 classrooms
in eight provinces, with the blessing of the Chinese government, which
has brought in more than 120,000 doctors to educate” (Wall Street
Journal, July 10, 2007, p. B1). Local doctors see videos that
deal with the kind of clinical situations that are expected to crop up
regularly. Distance learning courses such as these are cheap and
practical, but the trainees do suffer from lack of one-on-one contact
with a medical professional.
Blood Pressure Vaccine? Brain Pressure?
There are reports of a new blood-pressure vaccine “based on a protein
found in the sea creature the limpet. The new vaccine consists of
a course of three injections followed by a booster every six months;
the vaccine attacks a hormone called angiotensin which is produced by
the liver and is the main culprit in raising blood pressure.” (Pharmaceutical
News, 15 May 2007). Developed by a firm called Protherics, there are already
many questions about its efficacy. A Swiss firm, Cytos Biotechnology, is also reported
to be developing a similar product.
Interestingly, variant theories are now
appearing as to what causes high blood pressure. Some UK scientists
trace it to the brain, instead of the heart or blood vessels. We
suspect this will produce entirely new treatments that will affect
other parts of the causal chain. The University of Bristol,
which is spawning much innovative research reports:
Paton and his colleagues Hidefumi Waki and Sergey Kasparov, have
discovered a new protein, JAM-1 (junctional adhesion molecule-1), which
is located in the walls of blood vessels in the brain.
white blood cells called leukocytes which, once trapped, can cause
inflammation and may obstruct blood flow, resulting in poor oxygen
supply to the brain. This has led to the novel idea that high
blood pressure—hypertension—is an inflammatory vascular disease of the
article about this hypothesis appears in the June 2007 issue of Hypertension.
Try a Little Tenderness
The doctors have all sorts of wretched, leech sucking ways to make you
think you are getting better. If it does not hurt, it must not be
doing you any good. One of the mouthwash companies once improved
the flavor of its brand, and sales went into the tank. People
figured that if it tasted good, it must not be going you any
good. So the brand managers made sure, once again, that it tasted
awful. Now imagine our substitute for antibiotics—honey.
How, some will ask, could honey be good for what ails you?
commonly used in medicine before antibiotics became widespread. It is
still used in the Antipodes; an Australian company makes a product
called Medihoney for medicinal use. This formulation is a certified
medicine in Europe, but has not been much used there because doctors
developed a taste for prescribing conventional antibiotics.
Australia and New Zealand suggests that honey heals because it attacks
bacteria in several different ways at once. Because honey is composed
of saturated sugars, it sucks up water, depriving bacteria of the
liquid they need to survive and multiply. As bees make honey they
secrete glucoseoxidase, an enzyme that releases the bleach hydrogen
peroxide when it comes into contact with wound liquids. The low-level
but frequent release of this chemical ensures regular anti-bacterial
washes of the wound. (Economist, 26 April 1007)
honey seems to work against some of the deadly germs that are resistant
to antibiotics and that one finds in hospitals. (8/8/07)
Update: Honey for Coughs
Every time we turn around we discover new uncanny applications for
honey that touches on a variety of complaints. The Penn State College
of Medicine has discovered that it is a good thing to stem
children’s uncontrollable coughing, better in fact than many standard
cough medicines. “The study found that a small dose of buckwheat
honey given before bedtime provided better relief of nighttime cough
and sleep difficulty in children than no treatment or dextromethorphan
(DM), a cough suppressant found in many over-the-counter cold
medications.” See “Effect
of Honey, Dextromethorphan, and No Treatment on Nocturnal Cough and
Sleep Quality for Coughing Children and Their Parents,” Archives of
Pediatric and Adolescent Medicine, December 2007. (4/30/08)
Health Productivity Reforms
The Labor government is trying to get its arms around National
Healthcare Costs and Quality. First off, it is paying its
hospitals in a different way. Before they got block grants based
on previous budgets. Now they get paid by transaction, and the
hope is that they will do more for their money. But, too, there
is a counterbalance to make sure they are not doing lots of unnecessary
procedures. That is, the status of General Practitioners has
risen, and they will be gatekeepers with a budget who pass on whether
patients really need this or that treatment. See the
Economist, March 3, 2007, p.58. It’s the latter problem that
particularly affects America, where it is estimated that perhaps 1/3 of
the medical procedures that are rendered are rather unnecessary.
We’re doing a whole mess of medicine that does not help the
patient, and often hurts. (8/1/07)
Looking into Eyeglasses
does bring out of the closet one vital piece of information your
optometrist may not share with you. “The one crucial piece of
data most consumers are probably missing is the pupillary distance,
which is how close the eyes are to each other. That remains
fairly constant in adulthood, but it varies from one person to the
next.” “Any eye doctor or optician can provide the number.
It is against the law for an eye doctor to refuse to give you a
copy of your prescription. In most states, they are under no
obligation to provide the “P.D.” Some doctors, especially those
selling the eyeglasses, may refuse because they know that with that
number you can shop elsewhere. Just insist on it.” Insist
on it. (7/25/07)
Eyeglasses—and optometry—add up to one of the greatest scams in the
healthcare systems with gullible consumers paying $200 or more for a
pair of spectacles. Simple glasses should cost you $5, or $10 at
the worst. Sam’s, Wal-Mart’s warehouse discount unit, once
charged you $20 or so for 12 pairs, back before it got so heavily in
the jewelry and eyeglass business—and they had good frames to boot.
Now the average drugstore sells off-the-rack glasses with shoddy
frames for $15 a pair. The New York Times, May 5, 2007,
has done a credible job of looking at the problem in “Do-It-Yourself
Eyeglass Shopping on the Internet.” What it comes down to is that
you can find some wares on the Internet at better, if not fair, prices,
though it is still a fragmented, over-priced mess. “But a frame
that costs less than $25 to make in Italy can retail for at least $150
at an optical shop in the United States.” Zenni
Optical does seem to offer good bargains using China frames. Glassy Eyes reviews various
vendors—and tries to cut through the eyeglass scam. “Although the
frames carry fat profit margins, the real money for the retailer is in
the lenses. There the markup can be three to seven times the
wholesale price. Most single-vision lenses—those that are not
bifocals or the ‘progressive lenses,’ which are bifocals without the
line—are precast in large quantities and can cost about $1 to make.
The eyeglass dispenser just picks them out of a tray.”
“As of today, the Society for Vascular Surgery … is for the first time
recommending these three tests to screen for artery disease in many
people 55 years old and over” (Wall Street Journal, April 17,
2007, p. D2). They are: a carotid ultrasound to find fatty plaque
in neck arteries; ankle-brachial test to get at plaque in the legs and
throughout the body; and abdominal ultrasounds to see if the
aorta has a bulge or aneurysm. Some free offerings can be found
at www.vascularweb.org. A
high percentage of the nation’s strokes are attributed to carotid
“Companies that sell Coenzyme Q10 say daily doses improve heart
function and increase energy levels. Scientific evidence on
Coenzyme Q10 is mixed, and physicians urge patients not to stop taking
conventional drugs” (Wall Street Journal, March 27, 2007, p.
D2). Scientists are clearly mixed about it, though they generally
seem to agree that it offers no harmful side effects. There has
been an issue as to quality—with samples sometimes not including
intense enough quantities of the supplement. Then too, one must
test to find products with high enough absorption rates. “For
effective therapy in patients with heart failure,” one is apparently
striving “for 2.5 to 3.5 micrograms of the coenzyme for every
milliliter of blood,” compared with the normal .8 customarily found
before treatment. Advocates think it adds energy to parts of the
body where high energy is required. A wider range of
applications is suggested in some articles. While the WSJ
urges readers not to discontinue other heart medications when using it,
some researchers suspect that statins, beta blockers, and blood
pressure drugs may cut its efficacy. (7/11/07)
Is Very Low Key
“Mental health and blood pressure are a better guide to happiness in
Europe than economic performance.” A study of 16 countries found
that people who regarded themselves as happy had lower blood pressure.
“People in Sweden, the Netherlands, Denmark, the UK and Ireland
had the fewest blood pressure problems, while those in Portugal,
Germany, Italy and Finland were among those with the most” (Financial
Times, March 3-4, 2007, p. 2). “It is now well established
that people in richer countries tend to be happier,” but high economic
growth rates do not necessarily correlate with happiness.
Economists studying happiness have had mixed success uncovering what
kinds of things produce people with a high sense of wellbeing.
Abigal Zuger, a doctor herself, has written a very thin article about
“Doctors Who Wield the Pen to Heal the Profession,” New York Times,
May 15, 2007, p. D6. First off, we find that doctors who
write are mainly healing themselves, sensitive individuals who actually
have some guilt and remorse for the fact that they are made of mortal
clay and have committed some grievous errors along the way as they have
plied their trade. It is not altogether certain that their
writing, inspired as it is, really does much to change the profession,
which has structural flaws that are so deep that they will not submit
to the limited analysis of medical practitioners. She
particularly mentions two New Yorker writers, Atul Gawande and
Jerome Groopman, both best-selling stars of the moment, who are part of
the Harvard Medical/Mass General orbit. Gawande has written
convincingly about the venalities of the trade where habit and avarice
affect performance. Groopman has touched on many of the habits
and mental shortcuts that lead to poor diagnosis, something that even
led to poor treatment for him. One wishes that Zuger had dealt
with the raft of other fine medical writers such as Lewis Thomas of
Memorial Sloane Kettering,
Richard Selzer of Yale, and the incomparable Oliver Sacks—each
of whom is endowed with a special esthetic sense that takes their
writing to a higher plane. Consistently, incidentally, the best
writing in the New Yorker is about a health, probably
indicating that both its editors and readers are a bunch of
hypochondriacs. Henry Finder, its editorial director, is a
card-carrying health writer. (5/23/07)
Mottanai means ‘what a waste,’ and, more than ever, the Japanese are
eager to waste not. “Fruits and vegetables that are rejected for
sale because they are irregularly shaped or bruised are often thrown
away. Now, however, these otherwise perfectly good foods are
being used in purée form under the brand name
Nepurée.” See Trends in Japan, February 5,
2007. “Nepurée products are made from fruit or vegetables
that have been subjected to intense heat for a short time and then made
into puree form using centripetal force. The application of heat
brings out the sweetness that fruits and vegetables naturally contain,
and because no cutting instruments are used, the nutritional elements
are undamaged at the cellular level. The manufacturer Vegetech
Co. and its partner Kanto Orto Co. released products last year bearing
the message ‘the new shape of vegetables.’” (4/4/07)
Tips Before You Go to the Hospital
“If your ailment doesn’t kill you, the hospital will.” As we said
“Hyper-Germs and the Power of Soap,” hospital infections have
gotten much more deadly and claim a considerable number of lives.
AARP gives some good suggestions on things you personally can do to
guard against infection:
Wash your hands frequently. And don’t be
shy about reminding doctors, nurses and aides to wash theirs.
People who smoke or are overweight are
more susceptible to infection, so try to quit and lose before surgery.
Wash with 4 percent chlorhexidine
antibiotic soap for several days before surgery.
Ask your doctor for a nasal swab test
Be sure the doctor prescribes an
antibiotic for you before surgery.
Don’t allow the doctor to shave the
surgical site—tiny cuts from the razor can get infected. Use hair
Ask friends and family to stay away if
they’re ill, and ask the doctor to limit the number of aides and
medical students in your room.
Call a nurse
promptly if IVs or catheters become loose or damaged; the sites should
be kept clean and dry. (3/21/07)
China—Drugs, Hospitals, Tests,
The broken healthcare system in China—a great worry for the political
leadership—exposes even more dramatically the conflict between the
incentives built into the healthcare system and cost effective, health
effective healthcare. This is the same tension we discussed
previously in respect to Virgina Mason Hospital in Seattle. See
“In China, Prevention Pits Doctor Against System,” Wall Street
Journal, January 16, 2007, pp.A1 and A18. The Chinese have
lost the safety net offered in more doctrinaire times of public
services and healthcare: now citizens must pay stiff fees without the
aid of healthcare insurance. Doctors and hospitals are rewarded
for procedures and prescriptions, so large chunks of unaffordable,
expensive healthcare are inflicted on patients without particular
regard to outcome or cost effectiveness. The WSJ
discusses Dr.Hu Weimin of Loudi, who offers sensible preventive care
measures and low-cost prescriptions to a burgeoning population of
patients. He has been ostracized and even beaten by doctors and
barred from the wards of Loudi General Hospital because he has cut into
their revenues. “Academic studies show that 50% of all Chinese
health-care spending is for drugs.” Some 63.8% of medical
expenditures in China are paid privately, 87.6% coming out of the
pockets of individuals—higher even than the U.S. “With his Web
site, he manages some 7,000 patients and runs a high-blood-pressure
support group with 50,000 members…” (3/14/07)
Getting Hospitals off Drugs
One of the
impediments to health care reform is that the system incentivizes
doctors and hospitals to spend money on the unnecessary—and does not
reward them for frugality. In “A Novel Plan Helps Hospital Wean
Itself Off Pricey Tests,” Wall Street Journal, January
12, 2007, p. A1, we learn how Virginia Mason Medical Center in Seattle
has taken some halting steps to get off the tests, procedures, drugs
bandwagon. “A novel solution, crafted with the help of the big
employers, ultimately let Virginia Mason share in some of the savings
it created—by paying the medical center more for some cheaper
treatments. It offers a lesson in dealing with one of the most
confounding elements in America’s health-care crisis: a perverse system
of payments that rewards doctors and hospitals not for how well they
treat patients, but for how much they treat them.” “Virginia
Mason's move is a gamble. Only Aetna, which accounts for 10% of
the medical center’s business, has adjusted fees to reward its more
efficient care. Seattle’s two biggest health insurers, Regence
Blue Shield and Premera Blue Cross, haven’t matched the move so far.
Medicare, despite its own experiments, doesn’t have the
flexibility to change its payments for one hospital—and it accounts for
a third of Virginia Mason’s business. Virginia Mason, a
not-for-profit that is satisfied with an annual 1% to 3% operating
margin, still hasn’t replaced all its lost revenue.” “The medical
center has pursued efficiency by adopting some assembly-line methods of
Toyota Motor Corp. and Hitachi Ltd., which hospital officials and
doctors observed on a visit to Japan in 2002. For instance,
Virginia Mason rerouted patient traffic in its cancer center, cutting
the time patients had to wait for chemotherapy from four hours to 90
Cholesterol and Diet? Maybe
When one does
comparative analyses of heart disease incidence in various nations, one
can often find comparable disease rates in nations with quite disparate
fat intake rates. Namely, there are all sorts of anomalies that
suggest that the simplistic cholesterol studies by which American
doctors set their compass and which drives the vast dispensation and
usage of Lipitor and its statin cousins may not hold water. Also
more data on the danger of statins is coming to light which we will
share in a future entry. While looking harder at the science, we
would still say cut your fats; in fact, cut most everything except
vegetables and fruits. But don’t look askance at others who don’t
share your bias. For an very amusing look at some of the ‘fat’
anomalies, take a peek at the very amusing “The Case of
the Missing Data,” which suggests that our understanding of heart
disease is still pretty primitive, in spite of all the half baked
theories that are foisted upon us. (2/14/07)
Trust for America's Health
The Trust for America’s Health
is trying to put preventive health at the top of our healthcare agenda
and hopes to restore the public health system in the United States.
annual study just said that we are rather unprepared for any major
emergency, be it a pandemic or a terrorist threat. Buried in its
website are rankings of all the states according to a variety of health
yardsticks. In troubled states, one will detect considerable
weakness on child mortality and on other child issues. (1/31/07)
Hibernation for Humans?
Mark Roth has done research on “induced metabolic hibernation, in which
he has shown that it is possible to reversibly reduce the core
temperature of mice to 10 degrees Celsius without loss of life or
neurological problems,” which, in theory, could lead to breakthroughs
in the treatment of trauma and cancer. See
“Buying Time Through Hibernation on Demand,” Fred Hutchinson Cancer
Research Center Release, April 21, 2005. For an abstract, see
“H2S induces a suspended animation-like state in mice.” It is
thought that such treatment could, for instance, save accident victims
by putting them on ice, as it were, until they can be treated at a
full-scale emergency facility. (1/24/07)
Update: Ice Therapy for Cardiac Arrest
“The treatment is called therapeutic hypothermia and at its core is the simplest of technologies: ice. Once a patient’s heartbeat is restored, emergency-room doctors …are quickly applying ice to moderately lower a patient’s body temperature by about six degrees. Then the patient is put in a drug-induced coma in intensive care for 24 hours before gradually being warmed back up to normal temperature.” “How Ice Can Save Your Life,” Wall Street Journal, October 6, 2009, pp.D1-D2. It was formerly felt that if the heart stopped beating for more than 10 minutes, the brain would die: now revival has occurred with hearts out of action for 20 minutes or so. Historically only 10% of cardiac arrest patients return to health. (11-11-09)
Update: Therapeutic Hypothermia
"Researchers found that of 140 patients who got the treatment, in which the body is quickly cooled after the heartbeat is restored, 56% survived to be discharged from the hospital—92% of them with most or all of their cognitive function intact." Wall Street Journal, July 12, 2011, p. D1& D4. Cooling is applied as soon as a heartbeat is restored after sudden cardiac arrest, even as the patient is being transported to the hospital. "Generally, patients are cooled to about 90 to 92 degrees Fahrenheit, or about six to eight degrees below normal temperature. They are put in a medically induced coma for 24 hours before their temperature is gradually brought back to normal." (12-07-11)
Preventive Health Websites
Tallies Your Risk of Disease and Tells you What You Can Do About
It,” Wall Street Journal, October 31, 2006, p. D1. The site www.yourdiseaserisk.com,
created by the Harvard Center for Cancer Prevention, provides custom,
rather than generic information, to help patients understand their
health situation and the odds that they will get a severe
disease. “More important, it also spits out a tailored action
plan on ways to lower risk for health problems.” “Other Web sites
offer calculators to help users assess their risk for various health
problems.” The American Heart Association offers one at www.americanheart.org, but
it does not take into account enough variables. The National
Cancer Institute’s www.cancer.gov/bcrisktool
suffers from the same sort of problem: it does not take enough
individual variables into account. The Harvard site lets users
calculate their risk for “12 different cancers … heart disease, stroke,
diabetes and osteoporosis.” (12/27/06)
Hyper-Germs and the Power of Soap
We cannot over-emphasize the importance of the rise of
superbugs immune to traditional antibiotics—a topic on everybody’s lips
that is much remarked upon in the media. The New York Times,
for instance, opined that “Concern Mounts as Bacteria Resistant to
Antibiotics Disperse Widely” (August 22, 2006). We have
previously commented on “New Classes of
Antibiotics,” talking about some scientists who are trying
to develop radically different antibiotics that can do battle with a
range of pill-resistant diseases that have sprouted up. Oddly
enough, Big Pharma, puzzled by the difficulty of uncovering effective
new antibiotics, has dropped out of the fight. The infection
problems are accentuated by widespread and unnecessary use of
antibiotics which leads to the development of resistant bacterial
strains but which often kills off beneficial bacteria, especially in
the human gut. Promiscuous use of antibiotics in very young
children is credited with creating higher asthma rates, especially when
used in the first year of an infant’s life. Hospital infections,
especially in America, run rampant: it is such a problem that, by
default, rural populations often live longer simply because they don’t
have access to hospitals where they would otherwise stand a good chance
of getting a life-threatening infection.
Forbes (June 19, 2006, pp.60-74) does
a fine job with the subject in an article entitled “Germ Warfare,”
discussing “six strains of killer bacteria, built for destruction and
rapid reproduction and bred in hospitals nationwide, [that] are among
those that worry doctors most.” They are: Methicillin-resistant
staphylococcus (MRSA), which causes 100,000 hospital infections a year;
Clostridium difficile, which causes 400,000 cases of diarrhea annually;
Klebsiella pneumoniae, of which cases are up almost 50% in five years
and, when untreated, kills two-thirds of patients; Acinetobacter
baumannii, which is soil borne and heavily afflicts soldiers in Iraq
and Afghanistan; Vancomycin-resistant Enterococcus Faecium (VRE), which
is hard on those with weak immune systems and accounts for 10% of
hospital infections; and Pseudomonas aeruginosa, which accounts for 18%
of hospital-acquired pneumonia.
“100,000 Americans die of hospital -bred
infections” each year; “2 million patients get hospital
infections…. This crisis costs $30 billion a year.”
Sundry smaller companies are doing the
pathfinding work now on new antibiotics and other drugs. Stuart
Levy, a Tufts infectious disease expert, co-founded Paratek
Pharmaceuticals, which is testing a souped-up tetracycline. He is
author of The
Antibiotic Paradox, which deals with the over-use of
antibiotics and the subsequent outbreak of antibiotic-thwarting killer
bugs. Roy Vagelos, retired chairman of Merck, now heads
Theravance, which crushes fragments of old drugs to make powerful new
versions. He is aiming for a new and improved vancomycin.
Old-fashioned treatments, such as silver,
have shown considerable ability to reduce infections, as we mentioned
Standard.” As well strict observance of protocols in
intensive care units, with discipline reinforced at the highest level
of a hospital, can result in a “95%
Success Rate” in reducing infections.
The more things change, the more things stay
the same: cleanliness is still next to godliness. Simple
hand-washing and other old-fashioned hygienic measures among hospital
personnel, and particularly doctors, can cut hospital infections
dramatically. “Strict infection-control measures and prudent
antibiotic use have let hospitals in the Netherlands avoid the
resistant staph strains that plague most U.S. hospitals.
Hospitals test patients to identify carriers of staph, which
‘colonizes’ the nose when it is not causing infection. In the
Netherlands at-risk patients go into isolation, and doctors who are
carriers are sent home and can’t return until they are cleared, says
Margaret Vos, who heads infection control at Erasmus University Medical
Center.” Testing has reduced infections 90% at the University of
Pittsburgh Medical Center, and other tests are at various stages.
Prophylactic measures that prevent infection are more effective, and
more cost efficient, than drugs administered after the fact.
But we cannot under estimate the difficulty
of getting professional health personnel to take hygiene
seriously. Doctors are the worst of the bunch. Not to be
missed in this respect is “Selling Soap,” New York Times Magazine,
September 24, 2006, pp. 22-23. “In its 2000 report ‘To Err Is
Institute of Medicine estimated that anywhere from 44,000 to 98,000
Americans die each year because of hospital errors—more deaths than
from either motor-vehicle crashes or breast cancer—and that one of the
leading errors was the spread of bacterial infections.”
Cedars-Sinai in Los Angeles “needed to
devise some kind of incentive scheme that would increase compliance
without alienating its doctors. In the beginning, the
administrators gently cajoled the doctors with e-mail, faxes and
posters. But none of that seemed to work. (The hospital had
enlisted a crew of nurses to surreptitiously report on the staff’s
hand-washing.) ‘Then we started a campaign that really took the
word to the physicians where they live, which is on the wards,’ Silka
recalls. ‘And, most importantly, in the physicians’ parking lot,
which in L.A. is a big deal.’”
the nurse spies reported back the latest data, it was clear that the
hospital’s efforts were working—but not nearly enough. Compliance
had risen to about 80 percent from 65 percent, but the Joint Commission
required 90 percent compliance.” “They pressed their palms into
the plates, and Murthy sent them to the lab to be cultured and
photographed. The resulting images, Silka says, ‘were disgusting
and striking, with gobs of colonies of bacteria.’ The
administration then decided to harness the power of such disgusting
images. One photograph was made into a screen saver that haunted
every computer in Cedars-Sinai. Whatever reasons the doctors may
have had for not complying in the past, they vanished in the face of
such vivid evidence.” (11/15/06)
Update: Pre-Screening and Discipline
All that said, prescreening
of patients can make a big difference. “One strategy, long
popular in some Northern European countries and gaining traction here,
is to screen every patient admitted to the hospital, and isolate those
who are infected. This morning’s New York Times describes
a Pittsburgh VA Hospital that’s adopted mandatory testing of patients
and some simple measures to cut the number of MRSA infections from
about 60 per year to 17 last year.” (11/7/07)
Handwashing can do a lot. But more complex strategies seem to be
indicated in countries where super-infections are well
entrenched. Apparently scorched-earth policies in the Netherlands
and Scandanavia have kept in-hospital infections rates low. In
England, University of Bath researcher Mark Enright notes, the rates are
higher. Something different is required where microorganisms have
gotten well entrenched inside hospitals.
Working with hospitals around the country on MRSA, “the Sternins take
an unorthodox approach…known as positive deviance, or P.D., which
builds on …their health work in poor countries in Southeast
Asia.” Some are not suffering from the MRSA problem.
“Understanding precisely what the 30 percent are doing differently, and
then encouraging these positive deviants to educate the other 70
percent, can effect significant changes in group behavior.” The
MRSA rate at a Pittsburgh hospital dropped 50 percent after adopting
cleaning checklists and other notions suggested by everybody ranging
from doctors to janitors. An orderly at another hospital came up
with a good method of removing infected hospital gowns: his name
was Jason Palmer and this tactic is called the Palmer Method. See
more at www.positivedeviance.org
New York Times Magazine,
December 14, 2008, p.68. Jerry Sternin is working on this
initiative at Tufts University. The idea here is to what a what a
minority—sometimes a very small minority-is doing right, and using this
is a model for the whole group. Ibsen, we think, called this the
compact minority. (1/6/09)
In “Risk Pool,” New Yorker, August 8, 2006,
Malcolm Gladwell discovers that the dividing line between the Asian
Tigers (i.e, the high growth economies and companies of Asia) and the
American and European sluggards is dependency costs. In other
words, Westerners, and particularly Americans, are laying out huge
expenditures on a company by company basis for pensioners both for
health and retirement. Too high a dependency burden puts an
unsupportable overhead cost burden on all companies, particularly those
with overcapacity—such as the car companies:
The difference is that in most countries
the government, or large groups of companies, provides pensions and
health insurance. The United States, by contrast, has over the
past fifty years followed the lead of Charlie Wilson and the bosses of
Toledo and made individual companies responsible for the care of their
retirees. It is this fact, as much as any other, that explains
the current crisis. In 1950, Charlie Wilson was wrong, and Walter
Reuther was right.
Charlie Wilson was Engine Charlie Wilson, of
course, the famed leader of GM who railed against pooled pension
schemes, preferring to things on a company by company basis.
Walter Reuther was the auto union leader who understood that both
workers, companies, and the countries would enjoy more stable growth if
the burden was spread over a range of companies.
estimate that declines in dependency ratios are responsible for about a
third of the East Asian economic miracle of the postwar era; this is a
part of the world that, in the course of twenty-five years, saw its
dependency ratio decline thirty-five per cent. Dependency ratios
may also help answer the much-debated question of whether India or
China has a brighter economic future. Right now, China is in the
midst of what Joseph Chamie, the former director of the United Nations’
population division, calls the ‘sweet spot.’ In the
nineteen-sixties, China brought down its birth rate dramatically; those
children are now grown up and in the workforce, and there is no
similarly sized class of dependents behind them. India, on the
other hand, reduced its birth rate much more slowly and has yet to hit
the sweet spot. Its best years are ahead.” (11/1/06)
“Capsaicin, the chemical that makes chile peppers hot, may have the
power to destroy cancer cells” (The Week, April 7, 2006, p. 20).
Cedar-Sinai in California has discovered that it shrinks prostate
tumors in mice 80%, and, in lab tests, the spice killed 75 percent of
human cancer cells. See “Capsaicin, a component of red peppers,
inhibits the growth of androgen-independent, p. 53 mutant prostate
cancer cells.” See
191. Microbial Fat
“It’s clear that diet and genes contribute to how fat you are.
But a new wave of scientific research suggests that for some people,
there might be a third factor—microorganisms” (“Fat Factors,” New
York Times Magazine, August 13, 2006, pp. 28-33, 52-57). “One
year ago, the idea that microbes might cause obesity gained a foothold
when the Pennington Biomedical Research Center in Louisiana created the
nation’s first department of viruses and obesithy … headed by Nikhil
Dhurandhar.” Jeffrey Gordon at Washington University in St. Louis
believes obesity is related to intestinal microorganisms.
Cleanliness and Antibiotics Equal Allergies
A Duke study
tentatively confirms that the too-hygenic environment children
encounter in advanced developed countries plays a significant part in
the development of allergies. The study suggests that an overly
hygienic environment could simultaneously increase the tendency to have
allergic reactions and the tendency to acquire autoimmune disease,
despite the fact that these two reactions represent two different types
of immune responses. See
“Increased IL-4 production and attenuated proliferative and
pro-inflammatory responses of splenocytes from wild-caught rats (Rattus
norvegicus),” Scandanavian Journal of Immunology and other
articles. Meanwhile, British Columbia
researchers believe that asthma rates among children continue to
rise because of excessive use of antibiotics. Infants who intake
antibiotics during their first year of life are twice as likely as
other children to develop asthma. Earlier studies within the
United States have led to much the same conclusion. (9/27/06)
The Genes Will Out
For the first
time, really, gene therapy seems to be getting at tumors. See the
Wall Street Journal, September 1, 2006, pp. All &
A13. Such therapy had only worked in a very small cohort—2 out of
17 patients with advanced melanoma. Genes had previously worked
for other kinds of disease conditions, but this is the first time they
have bitten into cancer. The work was done by Dr. Steven
Rosenberg of the National Cancer Institute. He took T-Cells and a
receptor from one patient, and a couple of patients then showed
“dramatic and durable regression in their tumors.” They’re still
clear a year and one half later, and none of the patients are showing
side effects from the treatment. Rosenberg and others wondered
why the treatment did not work in more patients, speculating that a
weak receptor or other technical difficulties could have limited the
results. See the
National Cancer Institute. (9/20/06)
Heart Tricks While You’re Waiting
come in two basic designs, with the pump outside the patient’s body or
implanted inside the body. Current models are large, which
restricts their range of use. Patients must be confined to their
beds while using them, and the VADs’ large size prevents them from
being used on children and others with small bodies.
A string of recent technological developments in
Japan are holding out hope for patients awaiting heart transplants,
particularly children. The goal of the researchers involved in
these developments is to improve ventricular assist devices (VADs) by
making them smaller and more functional, so that they can be implanted
into young children and others with serious heart problems. VADs
help the heart to pump blood around the body. For patients awaiting
transplants, they play a critical role, helping them to survive until
transplant surgery can be performed.
But all that may change in the years ahead,
thanks to the development of a prototype of the world’s smallest
general-use VAD. The breakthrough is the result of joint research
between Tokyo Medical and Dental University and the Tokyo Institute of
The device’s pump, a critical component, is
circular in shape and small enough to fit into the palm of an adult’s
hand. It measures a mere 6.5 centimeters in diameter and is just
3.25 cm thick. Due to its small size, researchers believe there
is a high likelihood that the new VAD can be used in children as young
as 5 years of age for short periods of time. Clinical testing on
the new generation of VAD is planned for around 2009.
device is implanted into the body of a patient whose heart is extremely
weak from illness. It is then connected to their heart and sends
blood around the body through the turning of the pump’s impellers.
The researchers working on the project hope one day to develop a
device that can operate even when the user goes outdoors.
Another recently developed VAD is the
result of joint research in Japan by Sun Medical Technology Research
Corp. and several universities. This device is already in use in
one patient. The patient had it implanted in an operation in May
2005 and was released from the hospital the following February, after
recovering to the point of being able to stand up and move around.
The developers hope to have this VAD in widespread use in a few
Terumo Corp., Japan, a major medical
equipment maker, has completed clinical trials of its own VAD, expected
to be sold in Europe by the end of fiscal 2006 (April 2006 to March
promising developments are good news for transplant patients, many of
whom spend prolonged periods waiting for their operations. This
makes the VADs’ role of supporting hearts all the more critical.
(From Trends in Japan.) (8/30/06)
Online Brokers for Lab Tests
A host of firms
including MedLabUSA.com, MyMedLab.com, HealthCheckUSA, DirectLabs.com,
etc. are acting as brokers over the Internet to directly secure
consumers lab tests prescribed by doctors or simply desired by the
consumer. They have tie-ins with local labs in the area of each
customer. The savings can add up to 75% or more. Quest
Diagnostics and Laboratory Corp of America Holdings, the biggies in the
lab game, have held back from this market, since they are so tied in to
physicians and hospitals. It is anticipated that this market will
grow as consumers control more and more of their outlays in the
future. See the Wall Street Journal, June 20, 2006, p.
Checking out Prescriptions and Treatments
Reports long has
provided an online database on prescription drugs as part of a
partnership with the American Society of Health-System
Pharmacists. Now it has added in for a $9 annual fee herbs and
natural medicines from the Natural Medicines Comprehensive database of
the Therapeutic Research Center in Stockton, California, as well as its
guide to medical treatments. Conceptually this is a terribly good
idea, but we must add that the quality of these databases varies
immensely, and we cannot avow that CR has tied itself to the
right partners. (7/5/06)
185. Anthrax Killers
Not all biological weapons are created equal. They
are separated into categories A through C, category A biological agents
being the scariest: they are easy to spread, kill effectively and
call for special actions by the pubic health system. One of these
worrisome organisms is anthrax, which has already received its fair
share of media attention. But work in Vince Fischetti’s
laboratory at Rockefeller University suggests that a newly discovered
protein could be used to fight anthrax infections and even
decontaminate areas in which anthrax spores have been released.
“Anthrax is the most efficient biowarfare agent. Its
spores are stable and easy to produce, and once someone inhales them,
there is only a 48-hour window when antibiotics can be used,” says
Fischetti. “We’ve found a new protein that could both potentially
expand that treatment window and be used as a large-scale decontaminant
of anthrax spores.” Because anthrax spores are resistant to most
of the chemicals that emergency workers rely on to sterilize
contaminated areas, a solution based on the protein would be a powerful
tool for cleaning up after an anthrax attack.
All bacteria, anthrax included, have natural
predators called bacteriophage. Just as viruses infect people,
bacteriophage infect bacteria, reproduce, and then kill their host cell
by bursting out to find their next target. The bacteriophage use
special proteins, called lysins, to bore holes in the bacteria, causing
them to literally explode. Fischetti and colleagues identified
one of these lysins, called PlyG, in 2004, and showed that it could be
used to help treat animals and humans infected by anthrax. Now,
they have identified a second lysin, which they have named PlyPH, with
special properties that make it not only a good therapeutic agent, but
also useful for large-scale decontamination of areas like buildings and
military equipment (News Release, Rockefeller University, April 21,
hopes to combine PlyPH with a non-toxic aqueous substance developed by
a group in California that will germinate any anthrax spores it comes
in contact with. As the spores germinate, the PlyPH protein will
kill them, usually in a matter of minutes. The combined solution
could be used in buildings, on transportation equipment, on clothing,
even on skin, providing a safe, easy way to fight the spread of anthrax
in the event of a mass release. See the Journal of
Bacteriology 188(7): 2711-2714 (April 2006). (6/28/06)
we’re talking about “A Second Bullet for Cholesterol,” Business Week,
December 5, 2005, pp.77-78. What’s up is the addition of pills to
raise HDL, or good cholesterol. Sundry products are either now
being sold or about to be marketed, such as Niaspan from Kos
Pharmaceuticals (with about $400 million in sales), Acomplia from
Sanofi-Aventis, a weight loss drug with HDL cholesterol possibilities,
Torcetrapib from Pfizer which is mixed with Lipitor to provided a
one-two punch cocktail, and Avant’s vaccine. (6/7/06)
The first act in the drugmakers march against cholesterol
was a whole line of statin-class drugs, today led by Pfizer’s Lipitor,
which that company snapped up through an unfriendly acquisition of
Warner-Lambert. Lipitor is now ladled out at the rate of $11
billion a year, the heart doctors blind to the possible side effects of
the statin drugs. Cholesterol has been viewed as the prime
culprit in heart disease since the vaunted Framingham study, and one
only meets an occasional physician who looks at heart disease in a more
183. Close at Hand
The fine medical writer and physician Jerome Groopman
raises more than one interesting question in “Being There,” The New
Yorker, April 3, 2006, pp. 34-39:
emergency rooms in the United States treated nearly a hundred and
fourteen million people; about one in every hundred received CPR or
underwent another kind of resuscitation procedure. Resuscitations
are gruesome … and just fifteen percent, at most, are successful.
It’s a surprise to many that the revival
rate is so low, but it only emphasizes that CPR and other procedures
are best begun well before a patient can reach a hospital. In
“Distributed Defibrillators,” we underline the great success Las
Vegas has had, simply by putting defibrillators in casinos for quick
and easy access.
goes on to talk about a movement in medicine to close family relatives
into the emergency room to witness such crisis procedures. While
this practice is still not widespread, Groopman expects it to grow,
since openness plus patient and family involvement are becoming more
and more characteristic of modern medicine. (5/31/06)
182. Chiles and
A research team
at Cedars-Sinai Medical Center in California, in conjunction with UCLA,
has found that capsaicin (one of chile’s firey ingredients) shrinks
tumors some 75% in mice with prostate cancer. Phillip Koefler,
the study’s senior author, notes, in effect, that the capsaicin abets
“cell death,” a process cancer cells seek to avoid. Additionally
it tends inhibit cancer cell growth. See
Cedars-Sinai Release, March 15, 2006. See also
“Cancer Research.” And for anti-microbial aspects of spices,
and Life.” (5/24/06
has used fruit flies as proxies for mosquitoes in his lab experiments.
“Carlson’s daunting task was to identify the genes governing
insect olfaction.” It took him and colleagues until 1999 to
identify “the first odor receptor genes in the fruit fly.” The
thought is that repellants and attractants and other devices can be
developed that play on the olfactory genes of the mosquitoes.
The female mosquito, carrier of malaria, “locates her
human prey with her exquisite sense of smell. She can discern
human scent from 50 meters away.” Laurence J. Zwiebel of
Vanderbilt, John Carlson of Yale, and three other research groups in
Europe and Africa have joined together to see if these blood-sucking
killers can be brought low by their noses. They are developing
odor blends to lure mosquitoes into traps. See “Serial Killer,” Yale
Alumni Magazine, March-April 2006, pp.53-58. In 1986, Carlson
“established what was probably the only fruit fly olfaction lab in the
country and only the third he knows in the world.” Twenty years
later, there are more than 50. Attending a London conference on
mosquito olfaction in 1995, he learned that “10 percent of the world’s
population gets” malaria every year.
More and more,
we are discovering the part that metals and sundry minerals play in
inhibiting illness, and—in some instances—in provoking it. We
have discussed both arsenic and silver elsewhere. Brian DeDecker,
a cell biologist at Harvard Medical School, just has written abut the
role of gold and platinum in Nature Chemical Biology.
“Noble Metals Strip Peptides from Class II MHC Proteins,”
disabling the auto-immune system and possibly providing relief for
lupus, child diabetes, and rheumatoid arthritis. See The
Economist, March 6, 2006, p. 74. “Dr. Dedecker and his team
have screened some 30,000 chemical compounds … that might adversely
affect the proteins in question … without much success.” Just
recently they tried out drugs approved for other purposes: “two …
worked, and they had a surprising element in common: platinum.”
In general, not just platinum, but the whole class of noble metals
(such as palladium and gold) worked well. Some gold-based drugs
had long worked slowly against arthritis. Now that it is
understood that they curb MHC Protein, it is thought that faster acting
drugs can be devised. (4/19/06)
“Las Vegas casino security officers
have restored the heartbeats of about 1,800 gamblers and employees in
the past nine years, according to the Clark County Fire
Department.” See the Wall Street Journal, January 28-29,
2006, pp. Al & A10. Bryan Hindsoe, a George Washington
University emergency-medicine doctor and co-author of paramedic
textbooks, alleges that it’s now safer to suffer cardiac arrest in a
casino than at a hospital.
“Casino security officers have become so
adept” with defibrillators “that they usually decline offers of aid
from physician bystanders.” Authoritative bodies such as the
American Heart Association are now calling for wide distribution of the
devices and broader use by lay persons.
Richard Hardman, a paramedic in the Fire
Department, pushed the idea of casino personnel having and operating
defibrillators for the stricken. He got Stan Smith, vice
president of risk management at Boyd Gaming (Stardust Casino) to
“The state’s ‘good Samaritan law,’ giving
legal protection to bystanders who help in a medical emergency, was
extended to explicitly cover users of defibrillators, after lobbying by
casinos and Mr. Hardman.”
“The study’s survival rate astonished
specialists in emergency medicine. ‘This was groundbreaking—it
showed what can be accomplished with quick response,’ say Leonard Cobb,
professor emeritus of medicine at the University of Washington and the
father of Seattle’s paramedic program, widely hailed at the fastest-
reacting big-city operation in the country.” Now corporations,
such as Proctor & Gamble, and other institutions are laying in the
defibrillators which keep falling in price.
would further suggest that lay people should be both allowed and
trained to implement a number of doable medical practices which can
conceivably lead to broader, faster implementation of sound medical
practices at an affordable cost. We ourselves have seen that
experienced nursing personnel in hospitals and elsewhere can often both
suggest and render sensible medical procedures that would not occur to
physicians of rather narrow experience. (3/22/06)
178. Bird Flu
Bird Flu is on the fly, and it is
becoming a real worry. A case here and a case there is cropping
up—particularly in bird populations, brought on by wild birds on the
Scientists of merit are taking its moves
quite seriously, and are worried about a global pandemic. This
rise in concern, from a yellow to a red level if you will, has been
brought to our attention by Max Wallace, a healthcare and biotech
entrepreneur in the Research Triangle. We intend to give it a lot
of attention—right here.
The implications are many. It’s not
only a threat to people across the globe, but it already is having
business and economic implications. Some businesses are already
beginning their crisis planning, trying to imagine how they can carry
on with decimated labor forces. “Avian-Flu Concerns Overseas” are
dampening U.S. chicken exports, according to the Wall Street Journal,
March 11-12, 2006, p. A5. Several importers, especially in
Europe, are consuming less chicken, even though proper killing knocks
out the virus. “According to the World Health Organization, the
H5N1 virus has killed 97 people since 2003 in the developing world,
where people … live in much closer contact with poultry than they do in
the West.” “The wholesale price of so-called dark meat has
plunged to about 14 cents a pound in recent weeks, compared with about
41 cents a pound last summer.” Brazil plans to cut production
about 15%, but currently the U.S. production schedules calls for a
Mainland China, which already has rather
serious, unmet healthcare problems, is once again a source for this
latest flu, and some feel it is under-reporting its flu cases.
One wonders whether world public health bodies can do enough back
channel communication with China to begin to get at some of the sources
of its ongoing virus problems—or whether officialdom will try to
stonewall this growing problem.
There are outbreaks everywhere. See
“Sinister Droppings,” The Economist, February 18, 2006, p.
51. Italy, Greece, Austria, Germany. Official assurances
notwithstanding, chicken consumption has dropped 70%. Nigeria, a
heavy poultry country, has had an outbreak, though there are few signs
so far elsewhere in Africa. Both Azerbaijan and Iraq are
Controlling bird flu is a complex problem
and raises some of the very same issues that we encounter with other
kinds of viruses—computer outbreaks, terrorism, etc. It requires
intense collaboration that is not altogether easy, since the world’s
public health system is rather broken. Clearly there is fertile
ground here for the application of network theory—a growing body of
knowledge not well understood by governments anywhere.
It is perfectly clear that national
jealousies and scientific ambitions are an impediment to dealing with
the disease. Increasingly we are discovering that the only means
of rapidly dealing with emerging threats is efficient knowledge
markets. That means widely distributed nodes (researchers) bound
together by an open network as well as the will to work together.
… runs a database limited to a select group of scientists and
containing a massive trove of data—some 2,000 genetic sequences of the
virus, around a third of the world’s known sequences.” See the Wall
Street Journal, March 13, 2006, pp. B1-B2. Ilaria Capua an
Italian veterinarian working on avian influenza just received a sample
of virus from outbreak in Nigeria. Instead of supplying her
genetic data to the secretive WHO cache, she posted her findings on the
Internet in a public database. WHO, perhaps justifiably, says the
closed database is a compromise necessary to get some governments to
share the data: scientists agree not to publish results based on the
data without prior consultation. Officials and scientists from
the U.S., Switzerland, Croatia, Slovenia, United Kingdom, Iran, and
Niger have backed her stand, and often have given her permission to
make public sequences they have supplied. Her data is stored at
GenBank, run by the National Center for Biotechnology, part of the
National Institutes of Health. (3/15/06)
Airports. “The nation’s major airports aren’t prepared to quarantine a
planeload of international passengers, if someone is suspected of
carrying bird flu…” (USA Today, March 10, 2006, p.2A).
Honolulu is better prepared than airports on the mainland to spot and
handle flu suspects. The CDC is watching Hawaii to gain insight
as to how to control ports and airports in general.
Quantity Not Quality. More generally,
everyone involved with avian flu is having a hard time tracking
it—including the science, public health controls, outbreaks, dispersal
of the virus, etc. There are a host of sites—from WHO to national
authorities to self-invented experts: our team has not been able to
work its way through all of them. But we find that many have an
axe to grind, from furthering national or scientific jealousies, to
expanding on particular political biases. The UN is trying to do
a good job, but as might be expected with this and other institutions,
it falls behind the information curve, as events race ahead of its
statistics. We have yet to find a group that is doing a comprehensive
job of covering avian events, much less a site where the information is
presented in an accessible form.
The media is clear that it should be
watching, but does not know how to do it. The New York Times’s
Science Times (March 28, 2006, pp. D1-D8) devoted a special section to
the topic. It calls Avian Flu “The Uncertain Threat.” The
title article, which is in itself indecisive and wandering, is entitled
“How Serious Is the Risk?” Dr. David Nabarro at the UN is a
worrier; Dr. Jeremy Farrar at the Hospital for Tropical Diseases in Ho
Chi Minh City, thinks a human pandemic is unlikely, having watched the
slow progress of the disease over some 3 years.
Roeder. In the absence of an
authoritative and decisive news source, we suggest that researchers
track what we will call here science entrepreneurs who are trying to
manage, understand, and perhaps offer solutions to the disease.
In general the Wall Street Journal has been better at turning
up these people than other publications. See, for instance,
“After Fighting a Cattle Disease, Vet Turns to Birds,” Wall Street
Journal, March 16, 2006, which focuses on Dr. Peter Roeder, “a
60-year-old British veterinarian … who has spent decades fighting”
rinderpest in Africa and Asia, a devastating disease that has long
decimated cattle herds. “Dr. Roeder … has recently been in
Indonesia, helping lead the charge against another—the avian influenza
know as H5N1, or bird flu.” Roder knows that “mass vaccinations
don’t always work as well as narrowly targeted attacks on the
disease.” “The key to rinderpest’s defeat, he says, lay in being
selective.” Bird-flu experts are beginning to flock to his
thinking: at first they had been thinking about vaccinating
billions. Now they are talking about focusing on Guangdong
province which is a particularly feisty breeding ground. At a
macro level, Roder also makes a lot of sense: the general problem in
health is to learn how to leverage scarce resources for maximum effect,
so much of healthcare being stridently wasteful.
Niman. Dr. Henry L. Niman enjoys a
mixed reception in the scientific community, but, nonetheless, he has
been a successful communicator about bird flu, leading a voluntary band
of bloggists, who collect and spread information about. See “A
Bird Flu Watched Developes a Following Through the Internet,” Wall
Street Journal, March 24, 2006, pp. B1 and B4. In his
Pittsburgh home, “the 57-year-old biochemist keeps vigil over a blog
and explosion of offshoot internet discussion groups tracking the avian
flu virus….” “They believe mainstream scientists are missing
important clues about the virus’s evolution…” He now has his own
business called Recombinomics where he hopes to develop vaccines.
In general mainstream researches are skeptical about his research and
flu theories. He does think that we have moved decidedly closer
to a flu pandemic, obviously scaring his tribe of adherents.
Oddly, the WSJ did not appear to publish a link to his website.
It is helpful to peek at
WSJ’s Avian Flu Tracker, which is anecdotal but gives you a decent
sense of the evolving news.
George Mason. Curiously enough, not
many comment on the avian flu site that has been hatched by Tyler Cowen and Silviu
Dochia at George Mason University. The Masonites are doing more
“Avian Flu—What we need
to know.” It’s literate and wanders to some topics we do not
see elsewhere. Mr. Cowen has even authored a paper on the
subject: “Avian Flu: What Should be Done,” November 2005, which
is hardly definitive, but is creative and worth quite a look (Read the
full article, not the summary.)
Mr. Cowen and Mr. Dochia are economists, and we are yet to determine
how their avian flu chronicle connects up with their specific economic
interests, which we may learn about when we read Mr. Cowen’s other blog
“The Marginal Revolution,”
which is on economics and the efforts at the margin that can improve
economies. We are pleased, incidentally, to see that George Mason
has a flu information
page available for students that touches on the rudiments of flu
and avian flu. It is not very good, but at least it exists.
is soon to overtake Vietnam as the site of worst human outbreaks of
Avian flu. Forty-two people have died over the last year (New York
Times, July 21, 2006, p. A10). Thailand got control of the
flu by killing millions of chickens and by Vietnam instituted mandatory
vaccinations. Indonesia has tried limited vaccinations and flock
culling with limited success. (8/9/06)
Update: Bird Flu Vaccine
slowly but surely, the bird flu threat continues to intensify
(“Thailand Alert for Bird Flue Is Expanded,” New York Times,
August 6, 2006, p. 6). Officials have “put eight more provinces,
including the Bangkok area, on a bird flu watch list.” “The
outbreaks in Thailand and neighboring Laos, where bird flu was found on
a farm last month, renewed fears that the disease is flaring up again
in Asia.” “Indonesia and Vietnam have each had 42 deaths, the
highest number of confirmed human deaths anywhere in the world.”
GlaxoSmithKline reports that it now has produced effective
human bird-flu vaccine (Wall Street Journal, July 27, 2006,
p.A2). “In a clinical trial of 400 people, two doses of Glaxo’s
vaccine produced a strong immune response against the H5N1 virus in
more than 80% of the people who received it.” These results are
much better than those achieved with vaccines of other drug
Update: Microchip Flu Test
“Scientists have developed a microchip-based test that could allow more
laboratories to quickly diagnose and pinpoint the origin of flu
viruses, including the H5N1 avian-flu strain” (Wall Street Journal,
August 29, 2006, p. D4). The FluChip represents a research
collaboration between the Centers for Disease Control and the
University of Colorado at Boulder. It will ostensibly be two
years before “the test is commercialized” and becomes inexpensive
enough for wide laboratory use. Results were included in the
August 2006 issue of the
Journal of Clinical Microbiology. (11/29/06)
for Brain Cancer
We keep traveling around in circles. Silver, an old cure for
pesky infections, is now being revived to stave off hospital
infections. Once upon a time, arsenic (in the form of salvarsan)
was the only cure for syphilis. Now it’s the hope for some
intractable brain cancers. (2/22/06)
176. Silver Standard
critical application is to deal with runaway hospital infections.
There “bacterial infections” affect 2 million a year, killing some
90,000 patients. It is the worst problem in the hospital
environment, more fatal even than mistakes made in treatments and the
like. “The latest advance for silver therapy comes from AcryMed … that has invented a
process to deposit silver particles averaging 10 nanometers … on
medical devices” Its first customer, I-Flow, makes a silver-coasted
We have always preferred silver to gold—now we can
rationalize our aesthetic choice. Silver, it turns out, has
curative powers. Its use against bacteria dates back to the
ancients. “In 1884, a German doctor named C.S.F. Crede
demonstrated that putting a few drops of silver nitrate into the eyes
of babies born to women with venereal disease virtually eliminated the
high rates of blindness amongst such infants” (New York Times,
December 20, 2005, p. D5). Silver is staging a comeback, because
of bacterial resistance to many antibiotics and because scientists,
manipulating silver ions, can put together more powerful potions.
175. Just Medical Blogs
and Stossel does not get into this, articles in these journals are now
much, much reported on in the everyday press, even though the research
and results only add up to very tentative hypotheses. Journalists
and readers should be cautioned to take all this research with many
grains of salt. We are all too easily seduced by press reports on
journal articles: research has a way of flipflopping every few
Thomas P. Stossel, American Cancer Society Professor at
Harvard Business School, has correctly urged us to take medical
journals with a grain of salt. In “Mere Magazines,” Wall
Street Journal, December 30, 2005, p. A16, he finds that they are
regarded with too much reverence, in that the research they include (a)
is not subject to the rigorous detailed examination processes that are
required, for instance, in FDA reviews and (b) is normally
herd-driven—the articles that get accepted tend to tow the party line,
tracking current conventional theories in the medical field.
“Anonymous peer review by jealous competitors has its merits, but it
has a tendency to select for fashionable if relatively unoriginal and
inoffensive papers.” For this reason we should not get so
exercised when editors at the journals raise a storm about researcher
ties to corporate sponsors. Plenty of bad research creeps in with
the good under present editorial guidelines, and there is no clear
indication that corporate sponsorship of researchers, in whatever form,
has created tainted research we should suspect.
One really has to perk up when you come across a 95% success
rate. It’s a dirty secret of hospitaldom that infections run
rampant in our best institutions and there’s a good chance you will die
from them rather than from a high-risk operation on your next visit to
the operating room. But John Hopkins has found a way around this,
as we learn from Peter Kindlmann of Yale and Lee Schulman, president of
the Carnegie Foundation for the Advancement of Teaching:
thought-provoking reading. It is about quality control in
teaching, overtly here in a hospital setting, but by implication also
in an engineering program or a company. It proposes an aggressive
attitude, such as in the Johns Hopkins program (described below) which
is an aggressive drive to lower to zero the infection rate in intensive
care units. The protocols are stringent and are working.
Early on in this
new routine, every nurse was handed two phone numbers—the home phones
of the medical school dean and the university president—and told that
if a physician didn’t follow protocol and refused to abort the
procedure, they were to phone one of these numbers, even at 3 a.m.
That only happened once. The infection rate at Johns
Hopkins for that procedure is now approaching zero.
The piece concludes by asking how much
engineering education and student success in courses could be improved
by similar methods.
teaching institutions face many impediments, just like physicians; the
conditions and capabilities of our students are often unknown. But what
if at some universities the president was called every time a student
failed? This proposal sounds crazy, I know, but that’s just the
point. We’re too comfortable with our failures; we take them for
granted. The good news is that we can do much better. We know a great
deal today about how to organize our institutions and classrooms so
that students not only stay but achieve at high levels, and research in
the cognitive sciences and other fields provides grist for further
improvements. I know we lack the resources. I know we lack
the administrative and policy support. I know that some students
we inherit are already deeply wounded. Nevertheless, we need to
ask much more of ourselves. Education is no place for modest ambitions.
is abstracting the quotes from Lee Schulman’s “Immodest Proposal” which
can be found on the
Carnegie website. (12/28/05)
after Stroke. Again, the American Stroke Association provides
some boilerplate hope on how to deal with life once you have had a
stroke. But, in our opinion, you are best served to look at the
sites of thinking patients who have been through the whole
experience. You will find that the sites put up by patients and
their families vary widely in quality, but will often find the
practical hints that there that answer your particular needs.
Example’s are Joe and Jackie’s
and Stroke Survivors International.
The Stroke Information
Directory provides links to a number of survivor groups.
A Simple Test. If you think a friend has had a stroke,
give him or her this simple test: Ask him to smile; ask him to
raise both arms; ask him to speak a simple sentence. If he can’t
do one of the three, call 911 for emergency help. For more on the
success of this procedure, look at the American Heart Association’s
“Just a Minute.” Or, if you prefer, look up the more
list of warning signs on the American Stroke Association website,
which is a division of AHA.
at Royal Philips Electronics are developing pinprick blood sensors that
can detect certain diseases within minutes. Today’s blood screens
can’t spot malaria at an early stage, when the infection is still
treatable, because the tests don’t pick up trace particles of the
malaria parasite.” The Philips tests can, and the thought is that
it would have high relevance to early detection of heart
problems. It is trying to bring this approach to market as early
as 2009. See Business Week, October 24, 2005. Even
more exciting, we think, is the prospect of biometric sensing systems
which would not even prick the skin to read the blood. The
speculation is that they, too, could do very sensitive readings.
171. Surgery and Cancer
Years ago, when
we could offer cancer patients little hope in many instances, we
noticed that surgery seemed to exacerbate an existing cancer and hasten
the death of patients upon whom operations had been performed.
Recent studies suggest that “removing a tumor can trigger a process
that leads to new growth” (Wall Street Journal, September 13,
2005, pp. D1 and D3). “In a database of 1,173 breast-cancer
patients treated with surgery from 1964-1980 … 520 relapsed.” “In
a 2002 paper published in the journal Lancet, colon-cancer patients who
had traditional surgery had a significantly higher rate of relapse than
patients who had a minimally invasive laparoscopic procedure.”
170. Teeth without Pain
dental implant maker Nobel Biocare … received Food and Drug
Administration approval last May for Teeth in an Hour, a quick,
minimally invasive procedure for replacing several to all of a
patient’s teeth.” Using Nobel software, dentists do a CT scan of
patient’s mouth to perform an analysis. “Nobel’s Swiss factory
uses these plans to make a stencil-like mouthpiece, predrilled
with tiny holes to guide the dentist through surgery. Once the
patient is in the chair, the doctor can affix a set of new chompers in
about an hour.” There are 75 dentists doing the procedure now,
but Nobel expects to quickly train more. The treatment is pricey,
$2,000 to $3,000 per implant, or some $60,000 for the whole
mouth. See Forbes, September 5, 2005, p. 103 and
Cost Medical Care in India
Beeney’s story is becoming increasingly common as Europeans and
Americans, looking for worldclass treatments at prices a fourth or
fifth of what they would be at home, are traveling to India” (New
York Times, April 7, 2005, p. C6). Also x-ray scan interpretations
and lab testing is being done at low cost in India. (9/28/05)
168. Growth of Wound-Care Market
Concepts is expected to hit $1.2 billion this year, particularly
because of double digit sales of its line of vacuum-assisted wound
healing devices. Most of its wound healing technology was
acquired from Wake Forest University in 1994. Its vacuum
canisters keep wounds moist as well as sealing them to prevent
infection. “Other recent products include Smith & Nephew’s
Acticoat dressings, which incorporate microscopic silver nanoparticles
from NuCryst Pharmaceutical to enhance antimicrobial activity.
Another newcomer is a device from Celleration that uses ultrasonic
energy to spray a saline mist on wounds.” Johnson and Johnson’s
Regranex is a wound care gel incorporates blood cell proteins helpful
in early stages of healing. Oculus Innovative Sciences produces a
“superwater,” chlorinated water with charged oxygen ions that it claims
will rapidly kill bacteria, spores, etc. The resultant liquid it
calls Microcyn and it has had good results in Mexico, India, and
Italy. See the New York Times, August 5, 2005, p.
167. Cutting Down
on Cut Ups
Business Week (July 18,
2005, pp. 32-35) headlined a very provocative article called “Is Heart
Surgery Worth It?” To a host of medical experts, it is not at all
clear that heart surgery isn’t vastly overdone, and many would contend
it should be done away with except in instances where the patient is
clearly in dire trouble. Norton Hadler, medical professor at UNC-Chapel
Hill and author of Last Well Person,
thinks bypass surgery in particular should have been relegated to the
junk heap a decade ago. On the other hand, Dr. Timothy Gardner, a
cardiac surgeon in Delaware and co-editor of Operative Cardiac
Surgery thinks bypasses have worked very well indeed. Heart
surgery is $100 billion industry, and so there are not only health but
vast economic questions at stake. Further, the amount of surgery
done may be a proxy for a more general problem—runaway, costly, and
ineffective treatment throughout the healthcare establishment.
Both Fisher and Wennberg at Dartmouth have long claimed that a sizable
portion of healthcare is not driven by either need or results, but
rather by available supply. (9/7/05)
166. Ex-pounded Governor
remember that Governor Bill, later Pres Bill, had a terrible fondness
for all sorts of junk food, constantly battled his waistline, and
finally had to give himself over to major heart surgery. Now we
learn that current Governor Mike Huckabee is battling weight in one and
all. He shed 100 pounds by the end of 2004, all recounted in his
book Quit Digging Your
Grave with a Knife and Fork. See “The Governor Who Put
his State on a Diet,” New York Times, August 10, 2005, p. D2.
“His transformation led him to begin the Health Arkansas initiative …
the goal of which has been to persuade” his fellow citizens “to join
him….” Under the program, state employees “are given 30 minutes a
day for exercise.” They also get days off as a reward for healthy
living. If all this is not satisfying, one can buy Liza Ashley’s
Thirty Years at the
Mansion, full of recipes she used to fatten up 7 Arkansas
governors. Read about the fatty years at
surgeon Atul Gawande in “Piecework,” New Yorker, April
4, 2005, pp. 44-53, wrote sensitively and provocatively about doctors’
compensation and skyrocketing health costs. As he points out,
physician incomes are a fairly small part of the out-of-control health
care pie, but “we’re responsible for most of the spending.”
Nonetheless, some physician incomes are inordinately high. In
surgery, where one effectively gets paid by the operation, this leads,
among other things, to an excessive numbers of procedures. Recent
articles have speculated that perhaps 90% of all heart surgery should
not be done. Responsible studies, basically using Medicare data,
out of Dartmouth show tremendous treatment variability from one section
of the country to another, with no improvement in care or mortality in
regions with higher expenditures. Researchers, as a result,
believe that as much as 1/3 of our medical expenditures are
unwarranted, driven by an excess supply of physicians and medical
facilities. Perhaps a great deal of this waste results from trade
rules that allow a physician to get paid for procedures done or hours
expended—instead of for health results. (8/31/05)
164. Prostate Bible
A prostate specialist and
surgeon for 25 years, Dr. Peter Scardino has authored a book—Dr. Peter Scardino’s
Prostate Book—that looks at cancer, prostatitis, BPH, and
everything else that can go wrong with the prostate. As The
Economist points out, the book is sorely needed. Prostate
cancer, if caught early, is curable, and yet more men die of it than
any other cancer except lung. See The Economist, April 9,
2005, p. 70. Scardino is prostate cancer chair at Memorial
Sloan-Kettering. Interestingly, Scardino got his first degree
from Yale—in religious studies.
Scardino, prostate sufferers will want to read further. One site
with a great deal of digestible information is Phoenix5.org to
include links to articles such as the famous Andrew Grove account in Fortune
We cannot emphasize enough that the Phoenix site is terrific and it
should be consulted by anybody with even the vaguest interest in
prostate cancer. And here is yet another reading list:
www.seattleprostateinst.com/readinglist.htm. The sources on
prostate problems are wide and deep. (8/31/05)
163. Arsenic Aplenty
our “Ninety Degrees of
Uncertainty,” we touched upon the widespread arsenic contamination
of water supplied in both the United States and abroad.
Environmental Health Perspectives, June 2005, looks broadly at the
extent of this problem and at new tools for remediation, commenting
also on the range of illnesses—cancers as well as cardiovascular and
neurological complaints—that can result from this pollution. See Environmental
Health Perspectives. We have come such a long ways from 1910
when Paul Ehrlich introduced salvarsan (arsenic based) for syphilis in
those days before antibiotics, a time when venereal disease sufferers
had no effective remedy for their complaints. Now arsenic itself
is the hidden scourge. (8/3/05)
Dealing with Arsenic
previously talked about a world pervasive problem: drinking water that
is polluted by toxic quantities of arsenic. Wells dug some 30
years ago to give villagers in developing countries clean water have
turned out to have goodly quantities of arsenic. The wells were a
response to bacterially afflicted surface water that led to a host of
Finally in 2004 “Tommy
Ngai, an MIT graduate student, bought a round plastic bin at a street
market in Kathmandu, Nepal. He and the team filled it with layers
of sand, brick chips, gravel, and the magic ingredient—a layer of
locally bought iron nails, which chemically bind arsenic to them.
The filter may just be the MIT team's silver bullet, a
combination arsenic and biological filter. Cost: less than
$16.” Of course, this solution may work out in Bangladesh, one of
the hardest hit nations, but probably won’t apply to millions of others
with somewhat different water conditions in many other nations.
There’s a million-dollar prize out for a more comprehensive solution to
the arsenic, and teams at both Harvard and Columbia are working on the
162. The Ultimate
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
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)
Tests and Coumadin Safety
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
England Journal Of Medicine, June 2,
Disease in Seniors
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
First Year of Cancer (Installment 1)
Silicon Valley executive Stephanie Day has given us her first
thoughts about coming down with breast cancer—the discovery and all
that rush of things that occurs from the moment you know that it has
become your close companion. She and others such as Brian
McBain—who takes us through his years of heart disease in letters of April 7
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.”
Day by Day (Installment
Day’s wrenching battle with breast cancer goes on. As she has
said, the odds of winning are only about 50%. Yet she reports to
us that her doctor is cautiously encouraged: “I am still on chemo and
Herceptin three Fridays out of the month, with shots during the week
for blood counts and am feeling slightly more energetic. My
doctor believes that I am getting better....” Click here to read
her update. (10/26/05)
Never Passive (Installment
This installment concludes Stephanie’s first year of
wrestling with cancer, but, we are most happy to report, this will be
far from her last chapter. Cancer and hospitaldom leaves one
feeling weak and helpless, but it’s incumbent on anybody with such a
critical illness to (a) take charge of one’s fate, even if it puts one
at odds with medical professionals and (b) help the thousands of other
folks out there who are fighting this existential battle along with
you. In this installment, we learn that yet another divine Ms.
Day has spunk enough to call the shots and to give some tips to her
admitted that my body had finally said “enough.” Why should I
contaminate perfectly good new blood with poison when my oncologist
volunteered that skipping the last two chemo treatments most likely
would not make a difference one way or the other?
appreciated fully how humbling a disease cancer can be and vowed to try
to make a difference. Perhaps by relating my experience so far (I
have additional treatments to look forward to) with practical tips
along the way I can make it easier for one of those some 250,000 women
who will be diagnosed with breast cancer this year. (7/26/06)
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)
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
York Times, February 17, 2005, p. C5. (4/27/05)
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
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.
Towards Electronic Health Records
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
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).
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
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.
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)
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)
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)
Update: Nature's Malaria Issue
Nature, in a supplement Vol. 484 No. 7395_supp ppS13-S58, provides a global review of the war on malaria to include progress on vaccines, efforts to interdict mosquitos, etc. This supplement lacks a proper overview, but it seems, even with all the stops and starts in the malaria effort—on drugs, vaccines, etc---health workers have made good progress in cooler, richer, developed countries, but that the battle only seesaws in hot weather countries.
Readers should be aware that there are numerous other malaria citations in Stitch in Time to include entries 172, 181, and 242. (05/09/12)
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
147. Ranking Doctors and Hospitals
“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
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,
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.
Quite So Fat?
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.
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).
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.
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
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.
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.
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
Update: Japanese Take in their Belts
David Nakamura’s “How Japan Defines ‘Fat,’ ” Atlantic, November 10, 2009 tells us how Japan stays relatively thin through social pressure and Big Brother government. “In Japan, being fat remains noteworthy, something that makes you stand out in a shameful way in a conformist society. Even now, despite government statistics and anecdotal evidence that Japanese people are getting heavier, I can go days without seeing a single fat person in Tokyo.” “Last year, lawmakers established a national limit on waistlines for people 40 and older: 33.5 inches for men and 35.4 inches for women. The program, which aims to cut down on metabolic syndrome, a leading indicator for heart disease and diabetes, has been controversial and critics say it misses the mark scientifically.” “Not surprisingly, there are unintended consequences. Eating disorders are prevalent, especially among young women. When Ralph Lauren was criticized by the U.S. media after digitally altering an image of already-slender supermodel Filippa Hamilton to make her appear even skinnier, I was not surprised that a company executive said the advertisement had only appeared in Japan.” (12-09-09)
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.
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.
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.
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.
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).
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.
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
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
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
129. One Patient File
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.
Fatties Feeding Fresh
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
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
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
126. Yoga on the
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
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.
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
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
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
conference on September 13 and 14, 2003 was littered with interesting
people such as Jerome Kagan, Daniel Kahneman, Eric Lander, and Matthieu
121. End to Annual
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.
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.”
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
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
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.
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….”
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
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
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.
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
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
112. Kicking the Habit
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
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
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.
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.”
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.”
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
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
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
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.
Keys and More
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
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;
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.”
North Karelia Project
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
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
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
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
98. Drugs from Monsters
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?
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
95. Self-Help in China
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
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.
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
“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
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.
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.”
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
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.
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.
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
72. Learning How to Fight the
Courses on a University of Alabama website that teach
you how to diagnose anthrax, smallpox, etc. in the early stages.
71. Rick Mendosa's
www.mendosa.com/diabetes.htm. Both Mr. Mendosa and his wife
are diabetics. And he has aspired to be the world's best writer
about diabetes. (See entry #67 below.) He fits our
definition of a good care-giver: you must be afflicted yourself to
understand the problem. "This is a directory of diabetes-related
Web pages on this site and other Web pages written by me at the Web
sites of the American Diabetes Association and elsewhere."
70. Paperless and Errors -- Less So
GE Medicare Systems is pushing to digitize hospitals to
cut costs and errors. GE Centricity ostensibly chops away at
errors that "are estimated to kill up to 98,000 people a
year...." See Business Week, February 18, 2002, p. 93.
69. Drink Red
The scientists have been telling us for years how the
French eat rich food, drink a lot of red wine, and still have less
coronary trouble than Americans. Not just any red wine, though:
cabernets work better. The theory has been that red wine reduces
oxidants, but Dr. Roger Corder at London's William Harvey Research
Institute thinks the key is that the reds fight endothelin 1, a
constrictor of blood vessels. See The New York Times,
December 21, 2001, p. A17. Nobody is sure why this all works, but
we are indeed drinking up. And we like reds better anyway.
Update: A Belly Full of
For quite a while now, bibblers have rejoiced in the knowledge that
their consumption of red wine has something to do with avoiding heart
attacks. Of course, the Japanese drink very little red and suffer
less attacks than many in the West. The news is that scientists
are beginning to understand how the reds work their magic---in the
stomach, not in the bloodstream. “If the two mix in the stomach,
compounds in the wine thwart the formation of harmful chemicals that
are released when meat is digested.” (See The Economist,
July 5, 2008, p. 88). Dr. Kanner of the Hebrew
University of Jerusalem “hypothesized that if the polyphenols arrive in
the stomach at the moment when the fats are releasing malondialdehyde
and its kin, then this might stop these toxic materials from getting
any farther into the body.” In experiments he finds that the wine
does act on the malondialdehyde and also hydroperoxides, “another group
of oxidising agents that cause cell damage.” (10/22/08)
68. Medicine's 10 Greatest
Who knows whether the list is right, but it's a chance
to learn about some people we did not know. You can either read
Meyer Friedman's and Gerald Friedland's book,
Medicine's 10 Greatest Discoveries, or you can get a rundown at
Medicine's 10 Greatest Hits: Curiosity's Reward. The list:
a. 1543 - Vesalius' detailing of human anatomy.
b. 1628 - William Harvey on heart circulation.
c. 1675 - Anton Leeuwenhoek discovers bacteria.
d. 1796 - Edward Jenner uses cowpox to protect against smallpox, and
also uses other dead toxins to protect against other diseases.
e. 1842 - Crawford Long develops surgical anesthesia.
f. 1895 - Roentgen and x-rays.
g. 1907 - Ross Harrison grows living cells outside the body.
h. 1912 - Nikolai Anichkov discovers cholesterol is the basis of
coronary artery disease.
i. 1928 - Alexander Flemming and penicillin.
j. 1950-53 - Maurice Wilkins isolates single fiber of DNA, leading to
work of Watson and Crick who develop a double helix model.
Most of the great work, and most of the great
medicine, does not come from drug discoveries but from a better
understanding of how the body works. This tells us where medical
research monies should be directed.
67. More Than You Ever Needed to
Know About Sawtooth Palmetto
Rick Mendosa has done everything hip and complex, and
aspires to be the world's best medical writer about diabetes. He
is a good writer and he clearly has done the definitive article about
sawtooth palmetto. (See www.mendosa.com/sawpalm.htm.)
As one of my graduate students opines, "It's for bad pipes," which is
also known as benign prostatic hyperplasia (BPH), a condition that
often affects men in their 50s, when various swellings make for both
difficult and frequent urination. (If you're a literary sort,
read about Paul in John O'Hara's
A Rage to Live.) Now the doctors push surgery or drugs
for this condition because that's what doctors do. To his credit,
our own internist suggested sawtooth palmetto, though he could not
remember the best recipe which comes out of Germany, apparently.
The source of the new material for all the world, incidentally, is
Florida, with Germany, Switzerland, and Italy being the best
formularies. Bottom line: It's sold at Costco, but you may want
to look for finer grades. And the best worldwide standards for
alternative treatments, including sawtooth, seem to obtain in Germany,
so that's probably where the best alternative, quality drugs come from.
66. Cutting Diabetes
Weight is the story. A Massachusetts General study
headed by Dr. David M. Nathan, done for the federal government,
revealed "that even modest changes in living habits -- eating less fat,
exercising two and one-half hours a week and losing an average of 7
percent of body weight -- cut the incidence of diabetes by more than
half over a three-year period." Several oldsters know this is
true, but just can't get the deed done. Once again, prevention is
cheaper and better than drug treatment or other alternatives. See
the New York Times, January 15, 2002, p. D7.
65. Drugged to Death
"The 106,000 deaths from drug reactions tabulated by The
Journal of the American Medical Assn. for 1998 makes medication
side-effects the fourth leading cause of death in the U.S." See O'Dwyer's
PR Services Report, January 2002, p. 18 (www.odwyerpr.com). Another
big killer -- from the halls of medicine -- is hospitalization itself,
where we lose an extraordinary number of people.
64. Spend It Your Way
"Under a defined-contribution plan, each employee gets a
set medical budget--say $2,000 a year--which can be spent on virtually
any health service." After that, the patient pays everything--up
to a certain level, when the employee kicks in again. The thought
is that this will contain costs yet create employee satisfaction,
allowing each worker to run things his or her own way. Textron
(NYSE:TXT, www.textron.com) and
Medtronic (NYSE:MDT, www.medtronic.com)
are companies that are experimenting with such plans; Definity Health
Corporation is one company selling such plans to others. See the
Wall Street Journal, January 8, 2002, B1 and B4.
63. Cigarette Warnings Help
A Canadian Cancer Society Study "has found that larger,
more graphic health warnings on cigarette packs have heightened concern
about the dangers of tobacco...." Brazil and European Union
countries are also moving toward larger warnings. See The
Wall Street Journal, January 10, 2002, p. B6. It is unclear
is more people quit because of such warnings, however.
62. Absolute Puritanism
Theodore Dalyrymple (a.k.a. Anthony Daniels) is a
British physician and psychiatrist who is willing to take on the health
police. In this instance, the American Medical Association, gone
awry, has gotten mad about late-night liquor advertisements on
T.V. "In my own code, it required no advertisements to persuade
me to drink alcohol every day." "But health is not the only good,
much less the supreme good, of human existence. Indeed, excellent
health is neither sufficient nor necessary for the good life, and he is
not always happiest who lives longest." See the Wall Street
Journal, December 21, 2001, p. A14. Also, see Dalrymple's
several books, including:
Listeria: The Meaning of Health Scares
Little Done: The Testament of a Serial Killer
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
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.
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.
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
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
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.
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.
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
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..
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
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
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
42. Avoiding the Sweet
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
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,
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
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.
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
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
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
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
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
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
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
Catherine Arnst's excellent review of Laurie
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
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
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
Breast Cancer: Oncolink:
Cancer: American Cancer
Heart Disease: Heart
Prostate Cancer: Mediconsult
23. Reprise on Cholesterol
I have met more than one terribly talented doctor who
finds the fascination with cholesterol to be much overdone. Some
of us have observed that research into the effects of folic acid
suggest that cholesterol levels may be symptomatic, not causal, of
heart problems. Nonetheless, those who are enamoured of the
Framingham heart studies have now lowered the benchmark for acceptable
cholesterol well below 200.
One of our Chapel Hill
correspondents takes a different cut on the problem. He allows
that lowering cholesterol may promote lower cardiac risk, while raising
all other disease perils. That's the trouble with heart studies:
they just look at the heart. Periscope research sees the threat
just ahead, and misses the dive bombers just over the horizon.
Similarly, U.S. research on the health effects of microwaves (as
opposed to that done in Russia) has only looked at limited frequencies,
probably missing microwaves' deep, long-term threat.
Our reader has looked at the
"longest time period cholesterol study" that he knew of--work done in
Norway. "The Norwegians ... tabulated all causes of
mortality. Those who reduced their cholesterol had higher
mortality in every category except cardiac than the control group...."
By the way, brain cell membranes
depend on high cholesterol for their fluidity, according to our
correspondent. I suppose too little cholesterol leads to dry
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
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
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.
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,
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.
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.
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
15. Prostates In;
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
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
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.
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
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
"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
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:
Well for Optimal Health: The Essential Guide to Food, Diet, and
Healing: How to Discover and Enhance Your Body's Natural Ability to
Maintain and Heal Itself
Retrofitting the Brain
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
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.
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
Herbs Safer than Drugs?
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.
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
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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