Dr. Hugo Rodier

20-20 Vision Staring 2010

2010-01-05T08:19:00.000-08:00

As we start a new decade, let us see what “2020 vision” may have in store for us, according to a landmark issue in the Journal of the American Medical Association:

“As a result of rigorous scientific investigation, several therapeutic and preventive modalities currently deemed elements of complementary and alternative medicine will have proven effective. Therefore, by 2020, these interventions will have been incorporated into conventional medical education and practice, and the term ‘complementary and alternative medicine’ will be superseded by the concept of “Integrative Medicine…”

“[By 2020] most human diseases will be understood at the fundamental level of molecules; knowledge about genetic control of CELLULAR FUNCTIONS will underpin future strategies to PREVENT or TREAT diseases”.[1]

The only correction I would make is the term “Complementary and Alternative Medicine”. It is a pejorative word;[2] in my opinion, it has been coined by Big Pharma followers who view anything outside their narrow view of the world as an alternative. When all is said and done, any advancement in any field that is well researched, practical and affordable should be used as “medicine”, regardless of its source:

“Ultimately, there is only one medicine, those therapies that help patients... if it is good for medicine... it should be taught with respect and inquisitiveness and should be give an open-minded but rigorous approach”.[3]

[1] “2020 Vision: NIH Heads Foresee the Future”, Journal of the American Medical Association 1999;282:2287, 2288

[2] J. Family Practice, June 1999

[3] Institute of Medicine, 2004 report

On Sports and Movement

2010-01-05T08:09:00.000-08:00

Hopefully you have already seen the movie “Invictus”. I cannot do justice to the many messages it had for all of us. Suffice it to say that the poem “invictus” sustained me in my youth. As I got older, I came to see it as a bit arrogant but a necessary part of development; after being beaten up by life, I feel more comfortable saying that the invisible forces that guide my heart are now the captain of my soul.

Other than that, the movie’s wonderful example of the power of sports to unite people and promote health at so many levels resonated loudly in my heart. I played soccer in college and I still spend a lot of time watching the Utah Jazz, Real Salt Lake, and the Yankees (I used to live in NYC). I also exercise daily.

Let me share an article I wrote that got published in a Utah newspaper while I was an Intern in Houston, Texas; I wrote it in the throes of youthful exhilaration, a few days before my Alma Matter’s Football team won the National Championship in 1984:

“My name is not important. I am an ordinary Cougar fan who finds himself far away from Provo in very unfavorable circumstances. Right now it is 3 AM, a few hours after BYU beat Michigan in the Holiday Bowl. I can’t sleep for two reasons: one, my mind is filled with excitement and gratitude over BYU’s football team. Two, my old body doesn’t know when to sleep because of my work schedule.

You see, I am an intern at Baylor in Houston, a very hard working medical program. I am now rotating through the busiest Emergency Room in the nation. Since it was impossible to get the day off to watch the game (I would have had to work 72 hours straight) I told my boss I had to have the day off “for church reasons”.

I have been able to watch other games via satellite at church. Sometimes trading with other interns was necessary, which required working back to back nights. Why such fanatism? Because BYU football has been one of the few things I’ve had to keep my sanity since I began Pre Medicine in 1975.

While in Texas I have gotten in many heated arguments with the locals who feel there is no football outside their state; I even called a local radio show. Some Texans know about BYUs quarterback genealogy and that BYU does well on the gridiron when playing their teams.

The point I now wish to make is simple:

As an MD, I work trying to heal people. I have become aware of the futility of it in most cases. However, I am convinced that some things have a considerable impact on people’s wellbeing. One of them is sports. Not only active participation to build a strong body and character; but, also watching “your team” play. Both are excellent ways to grow; they also serve as a momentary break from daily obligations.

I am reminded of a colleague’s sad indictment on his knowledge of the human condition; he considered sports as much a waste of time as children’s games. How sad coming from a physician.

You see, sports and entertainment in general are very powerful activities in keeping a society health, happy and out of trouble. People from all walks of life find much relief from sometimes overwhelming environments through recreation—some through sports, others through all other forms of entertainment.

BYU football is an example of this in my own life. Think of the millions of workers who toil daily in honest but often poorly compensated drudgery. To them, watching their favorite team play is their major, if not the only outlet from it all. Sports not only release bottled up pressures, but, in some cases keeps a few from misdirecting those forces against themselves or against society.

Finally, I would like to thank all the players and coaches for a wonderful Christmas present which will hopefully lead to the National Championship. To coach Edwards, whom I admire immensely because of his leadership and perspective of the game, I would like to say that working as a coach he does more, much more in preventing disease and providing relief from sometimes brutal reality, than I will ever hope to do in a lifetime of work as a physician.

To the BYU players I say that they should never underestimate all the good things they do in pursuing excellence in their athletic endeavors. I have the utmost respect for what you do. Thank you very much”.

As 2010 comes your way, I hope you commit to exercising more often. If your work demands do not allow you to do it, consider walking with friends at lunch, or a neighborhood course in Yoga or Tai Chi; after learning you can do it on your own.

For those who live in Salt Lake City, consider taking my daughter Danielle’s Yoga class, starting January 6th at my clinic in Draper (Shameless plug). She is certified to teach Yoga after trotting the world over (Nepal, Indian, Patagonia, etc). Call her @ 801- 694-2489.

Doctors Weigh in on Health Care Reform

2009-12-21T08:35:00.000-08:00

Dermatologists feel reform is a rash decision
Gastroenterologists are getting heartburn over it
Internists feel it is a bitter pill to swallow
Gynecologists feel it is a bloody issue
Obstetricians expect changes to be delivered
Plastic surgeons want a new face on it
Surgeons wash their hands of it
Anesthesiologists think it is a gas
Pediatricians feel legislators need to grow up
Psychiatrists feel they are crazy in D.C.
And Proctologists think the A******* in D.C. are messing the whole thing up.

I am a Family Practitioner, but I agree with the Proctologists.

It is shameful how the outcome of health care reform seems to be shaping up as predicted: the big winners are the AMA, Big Pharma and Insurance companies. After all, they each spent over $10 million in lobbying.

Forget the public. Our Republic has descended into FASCISM, or the alliance of government and corporations.

If you have not started to look into self-sufficiency, community connections and food storage, you need to get going.

Still Ignoring New Research on Obesity

2009-12-16T15:00:00.000-08:00

You may have seen the recent study saying that the “increased food energy supply is more than sufficient to explain the US epidemic of obesity” (Am J Clin Nutr 2009 90: 145). If it is frustrating to me, not being overweight, I can imagine how frustrating it must be to all those poor people who don’t eat very much and cannot lose weight. Are you one of them? Even if you are not, you may have noticed that there is more to obesity than just counting calories.

The old “calories in = calories out” dogma does get you in the ballpark, but not to home plate. The essential issue ignored by the proponents of this outdated paradigm is that food is not just Energy or calories. Food = Energy AND Information, E&I.

I have talked about this issue ad nauseum in my newsletters and in my lectures (references on demand). The prime example is diet soda pop. Surely you have heard that it also makes people obese. Why? It has no calories; but it does have lots of bad Information: think of artificial sweeteners, and who knows what else they put in their secret formulas.

Processed food is the epitome of lots of Energy and very little Information. Our thermostat in the brain does not do well with poor E&I. In fact, nothing in the Universe does.

Here is a quick review of a powerpoint lecture I just gave in Niagara Falls, Canada, on the neglected issues behind the obesity epidemic:

• Metabolism: just like we have cars with different gas mileage, some of us are more efficient than others.

• TOILing membranes: our cell membranes, the brain of our cells, are Toxic, Oxidized, Inflamed and Lacking in optimal mitochondrial function. This TOILing leads to insulin resistance. Our cells are not getting proper E&I to do what they need to do, particularly in the hypothalamic thermostat.

• Xenohormesis: literally, “foreign control.” Very small amounts of micronutrients and toxins, whether in excess or in over-abundance, can have a profound effect on our cells requirements for E&I.

• Nutragenomics: the E&I in food affect our DNA copying. Even though we may have “obesity” genes,” we may overcome genetic tendencies by eating a good diet.

• Addiction: it is impossible to be thin when we are addicted to refined sugars. The addiction is as strong as a heroin addiction. Anyone trying to help people lose weight must be ready to assume the role of a counselor. Anyone wanting to lose weight must be prepared to go through sugar withdrawals.

• Food Politics: the food industry knows their refined foods are addicting. We cannot lose weight unless we are prepared to face head on the underlying, ubiquitous and relentless advertisement that makes the addiction so socially acceptable.

• Community structures: we drive everywhere we go. Our cities are built for “car standards.” We need to restructure them for “pedestrian standards.”

• Pollution: “persistent organic pollutants,” or P.O.P. are poisoning our cell membranes. One may be overweight, but no diabetes or other chronic diseases develop unless we are carrying too many pollutants. You did not read this wrong: pollutants are making us more obese. Get your doctor to check a GGT level in the liver. If it is pushing the upper limits of normal, you are running out of glutathione, the antioxidant in charge of detoxifying POPs.

• Gut connection: you may be colonized by micro organisms in the gut that are not only changing the way you process calories in the gut, but also screaming at you to keep feeding them sugar and chocolate.

• Thermostat: again, your thermostat may be TOILing. It may need antioxidants like alpha lipoid acid, resveratrol, and omega oils to get back on line. With a healthy thermostat we can “obey our hunger” and be satiated with healthy food. Have you ever seen anybody get fat on nuts, fruits and vegetables?

• “Birds of a feather:” if you hang out with obese people, you are more likely to become obese. This does not mean we should dump them, but that we could all resolve to eat better as a group.

• Mind-body-spirit connection: stress, loneliness, depression are closely related to obesity. We need to look inside our hearts for resolution of physical problems like obesity. In fact, abused children tend to be obese.

• Exercise: ok, this one is talked about, but not enough: you will never look the way you want to, unless you work out 1 hour a day. Sorry to put like that.

• Sex: there are not too many things that motivate people more powerfully than sex. For men this is a “duhhh” issue (for some women, too); for a significant number of men and women, it is a matter of how they look. Rather than hating me for stating the obvious, let us concede that losing weight for purely health reasons may not be as powerful a motivator as sexuality. Being open to more pleasure in sex may motivate many to change the way we eat and tackle the above issues. Let me say it another way: would you refrain from eating that twinkie if you knew that doing so will improve your sex life?

Of course, the amount of calories we eat is relevant. My contention is simply that calories are not the whole story.

“Ce n’est pas pas le germ; c’est le terrain”

2009-12-15T09:39:00.000-08:00

Several patients, hoping to have found the magic bullet that will cure their chronic fatigue, have brought to my office an article they feel shows that a retrovirus causes fatigue.[1] First of all, the article merely “links” the virus to fatigue; it does not prove a cause and effect relationship, which is what the authors recommend to do.

Are micro organisms to blame for all diseases? I don’t believe so. Attempts to do so are commonplace, given our present infectious paradigm in medicine. This is unfortunate and reminiscent of our general attitude to blame outside factors for our problems, including character and relationship problems. This is why I tend to side with Pasteur; after a brilliant career that included the creation of vaccines in the West, he ended up stating that “the germ is nothing; the terrain (or our immune system) is everything”.

The retrovirus is yet another clue that our immune system is not adequately protecting those who are affected by fatigue. If the virus was the main cause for fatigue we would all be tired, since that family of viruses is found in practically all people. When we consider that most of our immune system is in the intestines, we can see that any compromise of intestinal function will lead to poor absorption of the energy we consume in food; hence, fatigue. In other words, most immune system defects point to the gut.

Also, the immune system consumes significant amounts of energy. Food intake is the main factor in how our metabolism works, or how we use the energy of food at the cellular level. It is our metabolism that determines how strong our defenses may be against micro organisms. The worse our diet, the weaker our immune system is.[2] The other critical factor for both our metabolism and our immune system in the intestines is the friendly organisms that live therein. Pardon me for highlighting this concept so often, but the medical literature is abuzz with research into these wonderful organisms. The point here is that probiotics strengthen our immune system much better than all the garbage people take over the counter for their colds. A study showed that supplementing probiotics reduced rates of fever by 73%, cough by 62%, and a runny nose by 58% compared to placebo.[3]

[1] J. Science 2009;326:585

[2] “The Intricate Interface Between the Immune System and Metabolism”, J. Trends in Immunology 2004;25:193

[3] J. Pediatrics 2009;124:e172

November Books

2009-12-02T11:01:00.000-08:00

November books

Unaccustomed Earth
By Jhumpa Lahiri

She is a great story teller; very touching short stories of family and love relationships. The first one got to me the most, as I become “the old man” to my 2 grown daughters. Lahiri won the Pulitzer Prize with her superb writing (“The Namesake”).

The fly in the ointment is her constant name-dropping of Ivy League schools and higher education. Not that I am opposed to education, “au contraire”; I only argue that it does not confer superiority or maturity over people who have not had the same opportunities. If anything, “noblesse oblige”.
What about common Indian folk? No doubt she writes about her experiences and social strata, but, it would have been easier to swallow if she had included Indian immigrants from different backgrounds, just for spice. Nonetheless, this is a very good book.

Serpent of Light
By Drunvalo Melchizedek

Don’t waste your time with this one, unless you are a burnt-out new age hippie and/or you feel 2012 is going to bring significant changes (nothing wrong with that). The few pearls are:

1. The “spiritual center” of the Earth will move from Tibet to the Northern Chilean Andes.

2. Female sexuality needs to become more balanced with male sexuality. Yes, but the author says nothing about the reverse: what is good for the gander is good for the goose.

After Dark
By Haruki Murakami

I loved it! This is my second book by a very Kafka-like author. This very simple story takes place in one night. The writing is even simpler and more condensed than Hemingway’s. I enjoy simplicity, especially from the pen of a mature human being.

History is Wrong
By Erick Von Daniken

If you enjoy alternative history you may want to read this book, that is, if you can put up with the writer’s egocentricity, rudeness and unscientific tone. Van Daniken sold millions of copies of his book “Chariots of the Gods”, which alleges that the Gods were ETs. In this book Van Daniken gets into gold plates and Mormon lore. He also tackles Enoch/Thoth, who is a favorite of mine; I keep his figurine on my desk, next to Don Quijote.

Wisdom of the Ancients
By Francis Bacon (a.k.a. Shakespeare?)

Wonderful book if you are into scholarly writing. A must read for those who enjoy Greek mythology. Bacon examines ancient legends, tales, myths and fables and the wisdom contained in them. Read my blog “Wisdom of the Ancients” if you want to get a feel for this book.

White Guard
By Mikhail Bulgakov

I took one of my Russian patients’ suggestion to read about the Bolshevik revolution (calm down- I am not a communist) in Ukraine through the eyes of a young doctor. Bulgakov also writes, symbolically, about the revolution raging in the hearts of Russians: rich versus poor, proletariat vs. intelligentsia, etc.

It is unfortunate that here in the USA we have allowed ideologies to ignore the suffering of millions of Russians who lost their lives and/or were unfairly imprisoned through their revolution and WW I & II. Their losses, through many other historical events, have shaped their souls and produced unparalleled music, literature and science.

Suffering has a way of refining the human spirit. Or, it may lead us to alcoholism, addictions and many other self-defeating behaviors. The choice is ours.
But, Bulgakov is no Tolstoy or Dostoyevsky; his writing does not flow, at least not for me. If you enjoy history and a style of writing somewhat similar to Faulkner’s (translation factored in) this would be a good book to read.

Mammogram Controversy

2009-11-19T13:19:00.000-08:00

Not surprisingly, the recent statement by the US Preventive Services Task Force that women may not benefit form mammograms until age 50, and then recommending that they be done every other year, has been politicized. This is unfortunate; women are left confused and fearful.

I agree with the task force. Keep in mind that it still recommends that women under 50 be screened on an individual basis, if their special circumstances warrant it. So, why the fuss? Follow the money. Those opposed to any Health Care reform are screaming “rationing”, arguing that more of it would come along with reform. Yes, there would be more rationing; but that is exactly what we need, given the carefree spending health care corporations have instituted for themselves, not for the public.

What we need is clearheaded thinking to analyze the problems we have had on cancer screening for a long time. Many feel we have been doing more harm than good by early screening. Again, don’t have a cow: wait to read the whole article so that you may see that women at risk will continue to be screened as before.

Rather than give you my opinion on screening in general, read what I have copied form recent articles on the subject:

“Rethinking Screening for Breast Cancer and Prostate Cancer”,

“After 20 years of screening for breast and prostate cancer, several observations can be made. First, the incidence of these cancers increased after the introduction of screening but has never returned to prescreening levels. Second, the increase in the relative fraction of early stage cancers has increased. Third, the incidence of regional cancers has not decreased at a commensurate rate. One possible explanation is that screening may be increasing the burden of low-risk cancers without significantly reducing the burden of more aggressively growing cancers and therefore not resulting in the anticipated reduction in cancer mortality. To reduce morbidity and mortality from prostate cancer and breast cancer, new approaches for screening, early detection, and prevention for both diseases should be considered."

Translation: screening early may be a mistake. A significant number of cancers lie dormant and we die of something else. An aggressive cancer will kill us, anyhow; so, why worry for more years, having detected the cancer early?

“Contribution of Clinical Breast Examination to Breast Cancer Screening”, Breast cancer detection rates and sensitivity were higher, but so were false-positive rates, among mammography centers that offered clinical breast examination in addition to mammography,

"Overall, we found higher breast cancer detection rates and sensitivities for [clinical breast examination] referral than those previously found in other community-based studies, which suggests that the accuracy of [clinical breast examination] can be improved in screening programs that offer high-quality [clinical breast examinations] by specially trained nurses," the authors write. However, they note, the benefits of adding clinical breast examination must be weighed against potential risks and costs due to false-positive results and the anxiety associated with additional evaluations… For a theoretical population of 10,000 women between the ages of 50 and 69 years, the addition of clinical breast examination would lead to the detection of breast cancer in only four women whose cancer would be missed by mammography. However, adding clinical breast examination would also lead to false-positive results for an additional 219 women, the editorialists point out.”

“What is Wrong with Cancer Tests”,

Many experts feel that early detection of breast cancer, prostate cancer may not do any good. “Tests may be picking up small cancers that would never have caused any symptoms…Once they are diagnosed, almost everybody gets treated-and we know that treatment can cause harm.”

• “Screening’s power to cut risk of dying has been wildly overinflated…By the time cancer is big enough to be seen on a mammogram or other test, it’s already sent seeds to other parts of the body.”
• Detecting small cancers may not do any good. In Denmark a study showed that 39% of middle aged women who died of other causes had breast cancer at autopsy.
• 60% of men at age 60 have undetected prostate cancer; yet only 3% of deaths are due to this cancer
• Only the pap smear has shown a decreased in the risk of death
• Inflated numbers. For instance, colon cancer mortality drops by 60% with colonoscopies. But, mortality is really reduced from 2.3% down to 0.9%. “A benefit, yes, but not necessarily big enough to outweigh all other considerations.” If ½ of those people advised to have a colonoscopy got it done, it would cost more than $110 million dollars/year
• Better tests in the pipeline:
Oncotype DX test measures the activity of 21 genes in tumor cells to calculate the likelihood of the cancer reoccurring in 10 years.
ERG and PCA3 genes: if they are inactive in prostate cancer cells, aggressive therapy could be avoided.
• Screening may be right for you if:
You have a family history, you have a risky mutation, like BRCA 1&2 for breast cancer, you have already had cancer
• Think twice about screening if:
You have another serious illness (it may do you in before the cancer)
You are under 50 or over 70, you are significantly afraid of being harmed by treatment you don’t need
• Other ways you may be overtreated:
CTs involve a lot of radiation
MRIs for back pain are unnecessary
Back Surgery, Knee surgeries
Angioplasties or stents add no survival value over drugs and lifestyle changes, unless you’re in the middle, or aftermath of a heart attack.

Read the book “The Secret History of the War on Cancer” by Dr Davis if you want to understand why we are in disarray when it comes to cancer. We have known for decades that cancers are mutations of our DNA caused by toxins in the environment, poor nutrition and stress. But, we have not concentrated our efforts on these parameters; rather, we focus on chemotherapy, radiation, surgery and expensive screening for cancers that are already there. Why? Follow the money.

The book “Life’s Delicate Balance: The Causes and Prevention of Breast Cancer” was written in 2000 by Dr. Sherman, an Internal Medicine and Toxicology specialist, former EPA board member. She is currently teaching in the Department of Sociology at Western Michigan University on causes of illnesses in workers. She feels that the causes of breast cancer are endocrine active chemicals, pesticides, plastics, and radiation. She does not pull any punches:

“Why is our well funded National Cancer Institute not devoted its efforts to prevention of breast cancer? Has breast cancer, like so many aspects of our culture just another business opportunity? There is a massing, in a few hands, of control of production, distribution and use of pharmaceutical drugs and appliances; control of the sale and use of medical and laboratory tests; the consolidation and control of hospitals, nursing homes and home care providers. We are no longer people who become sick. We have become market. Is it any wonder that prevention receives so little attention? Cancer is a big and successful business! Reflecting on the purpose of the corporation to sell products and services and maximize profits, it becomes apparent that prevention cannot be in the interest of the bottom line. What a sad and bitter realization”.

The 2009 Nobel Prize in Medicine was awarded to researchers who discovered that the longer the tail of our chromosomes(telomere), the longer we live and the less cancers and chronic diseases we have. Well, guess what makes you telomere longer…. antioxidants, good nutrition. It turns out that good food like green tea, curcumin, cruciferous veggies, etc., decrease the risk of cancer by 2/3. Why was this fact not shouted on the 10 o’clock news?

Wisdom of the Ancients

2009-11-19T11:15:00.000-08:00

Modern technology has made our lives much easier in many respects. All fields of human endeavor have dramatically benefited from modern scientific miracles. Medicine is no different. Looking back on history one may be tempted to assume that former lifestyles and technologies where “backwards”, or “primitive”. While this would be true in many instances, such conclusion would deprive one of considerable wisdom that may be applicable even today in our technology-driven society.

The wisdom of the ancients, in the form of fables, mythology and legends, is redolent with advice we would do well to heed today. In my opinion, the state of our society with its multiple social, political and economic problems may well be a sign that our technology has not been enough to avoid said maladies.

The tug of war between technology and natural things, or Mother Nature, has raged from the dawn of mankind.

“Vulcan (the God of technology/science) raped Minerva (Gaia/Mother Earth), the consequence of which was the birth of Ericthonius, whose body from the middle upwards was comely and well proportioned, but his thighs and legs small, shrank and deformed like an eel. Conscious of this defect, he became an inventor of chariots, so as to show the graceful, but conceal the deformed part of his body”.

The same tension between opposites has been symbolized by every society in different ways. For example, the ancient pre-Christian sign of the cross, which symbolizes both as above so below, also represents the resolution of the tension between both extremes; in fact, the ancient auroboros, or the snake eating its own tail also means at-one-ment. Think of the Yin-Yang, or Plato and Aristotle pointing up towards the heavens and down towards Earth while they argue about whose viewpoint is correct.

I do not wish to contradict anyone who would take the side of science 100%, or for that matter, doctors who feel our Health Care system is the best in the world. They do have a point. I only wish to suggest that one may then be watching Ericthonius riding by on his chariot and only seeing him from the waist up. And he is beautiful.

Let’s do an exam below Ericthomius’ waist:

1. Technology has brought on unsustainable industries that cannot continue without severely compromising our very lives on planet Earth.

2. The pharmaceutical industry, which began by using products from Mother Earth to treat people (herbs, micro and macro nutrients composed 80% of pharmaceutical products until 1990; now it’s 50%) is now encouraging the indiscriminate use of pharmaceuticals for many conditions that are, for the most part, benign issues. Practically all problems are addressed with pharmaceuticals, instead of focusing on the underlying factors (nutrition, stress and toxic environments) that lead to diseases. Polypharmacy, side effects and exorbitant costs are among several other problems we may see, while chronic care is not managed optimally.

3. Medicine often relies on expensive technology and invasive surgery to replace good judgment, and communication with patients. “In the current environment the balance has tipped toward market exchanges at the expense of medicine’s communal dimension”. Defensive medicine adds fuel to the flames. Disturbing reports continue to emerge that the practice of medicine is in many cases driven by expensive technology to maximize profits for those involved. “The role of the doctor is diminished to one of a competent technician who is interchangeable with any other with similar training… the same is applied to patients… they become interchangeable units of health need”.

4. The internet has dumbed down our society. Doctors are not immune. While surfing the net for information, very few are compelled to dive under for depth. Our children’s writing and comprehending skills are so deteriorated that most corporations have remedial English courses for new hires. The story of Ulysses comes to mind. He was tempted by the song of the sirens promising unbounded knowledge. He knew he would go mad if he yielded to the false promise of vast information with no wisdom, balance or integration. I am afraid that we, doctors are not immune to the sirens’ music.

5. Medicine and our society as a whole have over-emphasized the male aspect of our nature in favor of a more competitive, logical approach, while relegating the equally important feminine side of our nature. Cooperation, communication and feelings are not favorably received in corporate circles. I am afraid that often the same attitudes are found in medicine. We denigrate intuition in favor of logic, instead of marrying the two. We prefer aggressive interventions rather than spending time helping our patients change their lifestyles. While there is a place for acute medicine, the same “masculine” approach to chronic problems is not the answer.

“Deeply concerned about the dehumanization of health care... emotions of knowing intuitively that the way medicine is now taught and practiced is simply wrong, that the humane is being supplanted by unfeeling science and uncaring economics”.

Practically all facets of human endeavor seem to be affected by the rape of Nature. Think of the ills of industrial agriculture, environmentally unsustainable energy production, cities valued above small towns (rural medicine), etc, etc. A more comprehensive view of our society is likely to yield many other examples of Ericthnonius at work, unless you are inclined to think that technology is King. My point is the King needs a Queen.

Are You at Higher Risk for the Flu?

2009-11-09T09:29:00.000-08:00

Yes, if you are insulin resistant and/or overweight. So says the JAMA November 4th2009 (“Factors Associated with Death or Hospitalization Due to Pandemic 2009 Influenza A(H1N1) Infection in California,” JAMA 2009;302:1896).

But, this is nothing new. Dr. Otto Warburg won the Nobel Prize in Medicine in 1931 by demonstrating that our immune system is less than optimal when our blood sugar levels are elevated, which is the case in some insulin resistance and obese people.

Read my other blogs on the flu.

While most patients are not going to change their diets to decrease their risk of doing poorly with the flu, I would think that some may listen, given the fear that drives them to stand for hours outside some clinic to get the vaccine. I say we publicize these ideas and let people decide.

The bottom line, as always: “it is not the bug, it’s the terrain.”

Docs on Coke

2009-11-09T09:27:00.000-08:00

The Deseret News reported November 5th 2009 that the American Academy of Family Physicians formed an alliance with Coca-Cola, ostensibly to advise the public about soft drinks and health. Coca-Cola will give the Academy hundreds of thousands of dollars on the deal.

This is sick. Many doctors are quitting the Academy over this.

If the public needs advice on soft drinks I will do it for free: DON’T DRINK LIQUID CANDY AT ALL!

If you want to study the evidence against soft drinks send me your Email and I will attach the references I have found over the years about the health problems we see with soft drinks.

This is a glaring example of what is wrong with our Health Care system: it has become a business, despite the evidence and the history that health care does not behave like a business. While we all need to make a living, I believe that the system itself should be not-for-profit. Which leads, like everything else, to health care reform; it won’t do a bit of good to haggle over how to finance the present dysfunctional system, unless we put prevention and wellness in front where it belongs.

“I Know My Thyroid is Not Working”

2009-11-09T09:23:00.000-08:00

I hear this from a lot from a significant number of patients who feel practically all their symptoms (fatigue, hair falling out being the most common) are due to their thyroid, despite normal serum levels. They frequently add that they have been told or they read on the internet that it is common to have thyroid dysfunction that does not show up in the testing.

Chances are you have also contemplated this dilemma. Assuming you are reading this because you respect my opinion, I will pull no punches in telling you what I believe is going on. If you don’t respect my opinion, then go find a quack down the street who will happily prescribe thyroid for you.

1. If we believe that blood levels are inaccurate, then, we must put EVERYONE on thyroid, since just about all patients have symptoms that could be attributed to low thyroid. By the way, most fatigue is from nutritional issues, stress and lack of sleep. Most hair loss is associated with deficiencies in intestinal absorption of nutrients, and stress.

2. Disreputable practitioners thrive on prescribing thyroid; their patients love them, because they “listen” and because the stimulant effects of thyroid are welcome by those who are comfortable with such an overdone pharmaceutical approach. But, within months of using thyroid that is not needed, these patients begin to feel the overstimulation: no problem! Your friendly practitioner will prescribe valium, xanax and sleeping pills for you. The myth that blood levels are not accurate is, in my opinion, perpetuated by these practitioners. It is true that even a broken clock will tell time correctly twice a day; no doubt there are patients whose tests are not accurate. But, they are rather the exception, not the rule. These patients deserve a complete hormonal work up, including insulin resistance and pituitary assessment, not “a trial of thyroid Rx.”

3. There are over 500 chemicals in the environment, in addition to background atomic fallout from Nevada’s nuclear testing legacy. No doubt they contribute to the strain that our thyroids are under. Add poor diets, hyperinsulinemia and adrenal stress and that makes the Dx of hypothyroidism top the list of problems we have. This should give us pause and make us more conservative in reaching for the prescription pad, instead of handing the hormone out to anyone who asks for it.

4. If you end up needing treatment:
Levothyroxine is very good. I am taking it myself. It may be taken once a week. AND, it is quite natural, as much as desiccated pig (Armour) thyroid is. Since the latter comes form pigs it is not quite the same as human thyroid (if you start oinking while on it you now know why). Yes, levothyroxine is just as natural. Even though it was made in the laboratory, it has been structured to virtually mimic our own native thyroid hormone. Think of insulin: science has advanced to such a point that these hormones are virtually “natural.” Think also of H2O. We make it in the lab to be equal to what we get from clouds because we know its structure.

5. Most people do not need T3 when they get T4. The body converts T4 into T3 at the correct rate. Each organ does it according to its own needs. The skin needs a whole lot less than the heart and brain. Other organs need different amounts somewhere in between the organs mentioned above. A blood level will determine if conversion from T4 to T3 is taking place. To take Armour just to give T3 is not a good approach. Armour has a fixed amount of T3, which is much higher than the levels our body needs in relation to T4: all organs then end up on the same excessive amount of T3, which may create problems, particularly with the heart (it happened to me).

6. Armour is reported to be going off the market due to low demand (docs don’t like it because of the above issues). So, my advise to you is to accept your docs’ prescription of levothyroxine, if you really need it.

REGULAR and H1N1 FLU

2009-10-29T12:32:00.000-07:00

When discussing any infectious issue, the emphasis is generally on the virulence of the organism. While this is a legitimate concern, this approach often creates some fear and apprehension in people. At times, patients may even feel totally helpless.

At our clinic, we believe that a preventive approach should be equally, if not more emphasized, to empower people to boost their immune system and avoid victim-like attitudes that may further compromise their immune system.

Pasteur popularized vaccinations in the Western world. After all his work, it is telling that he came to believe that the problem with infections “is not the germ, but the terrain.” In other words, strengthening our immune system, which is mostly found in the tissues, especially in the gut and sinuses, gives us reasonable assurance that we could defend ourselves from any infectious organism with a higher chance of success.

Things to do to strengthen our immune system:

1. Get adequate sleep. Losing one hour of sleep per night depresses immune function.

2. Wash your hands often. Try not to touch your eyes, mouth. Sneeze into your sleeve.

3. Take 5-10,000 IU of Vitamin D3 each day. Increase to 50,000 IU while sick. Children: 1,000 IU daily, 5,000 IU when sick.

4. Take Vitamin C: 1,000 mgs. Increase to 5,000 mgs 3 times a day while sick; add IGG 2000 (immunoglobulin) 2 caps twice a day.

5. Take probiotics 5-10 caps a day; feed them with Slippery elm or Constant Health fiber.

6. Avoid processed sugar: one can of coke depresses white cell function by 90% for 5 hours.

7. Take Echinacea, Mushrooms, Elderberry and/or Silver only while ill. They are not indicated for maintenance.

8. REST!

9. LOTS OF WATER. Pomegranate, green tea would be best.

10. Consider wearing surgical mask if risk of exposure is high.

If you believe you have the Flu:

Try the above suggestions.

The CDC advises patients to stay home and rest; avoid the ER and clinic, unless you are extremely ill. In that case, come in wearing a surgical mask. The main thing we would do is to give you a Myer’s cocktail by IV route with fluids. Prescriptions for cough and pain would be considered.

October Books

2009-10-28T13:46:00.000-07:00

Nocturnes by Kazuo Ishiguro
I loved it. His writing is so clear and simple. He has amazing benevolent insights into human nature. This book is especially good for music lovers. Ishiguro became well-known with Remains of the Day, which became a movie. That book helped me understand Great Britain better.

Decipher by Stel Pavlou
What a waste of time; terrible writer from an immature person. However, the topic may be appealing to some (it was an international best seller). If you like stories about Atlantis, Aliens, symbols and physics, you may risk reading it.

Darwin’s Black Box by Michael Beher
That’s it! I am finally getting off the evolution bandwagon. Beher does a great job explaining the science behind the objections to evolution. Darwin did not know much about cells when he wrote. NeoDarwinians need to read this book if they are to continue supporting the old bigot.

America’s Secret Destiny by Robert Hieronimus
Not worth reading. I can tell you about the one pearl in this one: Our Founding Fathers were inspired by the writings of John Locke and Jean Jacques Rousseau, who in turn got their revolutionary ideas about democracy from the Iroquois in the Northeastern USA and Quebec province. A federation of 6 Native American tribes was firmly established, with equal rights for all, including women, when the white man came to America. In fact, they had to be “Americanized” to survive.

Hieronimus also talks about the Great Seal of the USA, dispelling a lot of the conspiracy theories surrounding it.

Spontaneous Evolution by Bruce Lipton and Steve Bhaerman
A MUST read. Lipton continues where he left off in Biology of Belief. He teams up with “Swami Beyondanada” to lighten up the heavy nature of the topic. Basically, they join the chorus of people getting off the Darwin bandwagon by showing how stress can cause spontaneous mutations. According to them, and many others, humans are about to take another leap in the evolutionary journey. This time, I hope, we will be able to mimic our body’s cells’ approach to living; all 50 trillion of them have learned to live in harmony, not in competition. “Survival of the fittest” got us in the terrible mess we are in. We need a more feminine-cooperative approach if we are going to make it.

Dealing with Chronic Pain: A Missing Tool

2009-10-20T09:39:00.000-07:00

Many of us suffer daily with intractable pain for one reason or another. Doctors try to help with pain medications. Other medical workers concentrate on physical therapy, acupuncture, massage, chiropractic adjustments, hypnotherapy, etc.

These modalities are successful in many cases; yet, chronic pain, particularly arthritic inflammation, is seldom dealt with to everyone’s satisfaction. I believe a seldom used mode of dealing with the pain is focusing on nutrition and the way we process food in the intestines. The recent article “Increased Frequency of Gastrointestinal Symptoms in Patients with Fibromyalgia and Associated Factors” (J. Rheumatology 2009;36:1720) is not the first article to bring up the association between inflammation and our intestinal function. We have known about inflammation arising in the intestines since Metchnikoff won the Nobel Prize in Medicine in 1908.

The implications of this article are far reaching; at least in my clinic, where we are able to help patients with arthritis inflammation 80% of the time.

Sadly, most people are not willing to change their diets to minimize the toxic intestinal environment that begets inflammation. Worse, most doctors continue to ignore articles like this one; they are not able to offer patients the choice that some may welcome to decrease pain.

Sometimes patients are told that they have genetic tendencies that cause the inflammation, ignoring the cutting edge reports that each gene may express up to 30,000 proteins. (J. Cell 2000;101:671) This means that any gene may or may not lead to inflammation: it all depends on environmental clues, like nutrition, toxins, and even our thoughts, beliefs, and relationships.

The article “Transposable Elements: targets for early nutritional effects on epigenetic gene regulation” (J. Molecular & Cell Biology 2003;15:5293) simply means that “control from above” (epigenetic) can decrease an inflammatory genetic tendency; if we change our diets, clean up our environments and improve our thoughts, relationships and beliefs we have a good chance to manage a lot of our pain issues. Of course, there will always be cases where more traditional treatments will be needed.

On a similar note: Why does our health care system “hurt?”
Could we stop the pain (manage the cost) in a more sustainable way?

Hopefully someday we will focus on teaching patients these simple concepts.
Maybe someday we will stop spending most of our money on weapons and concentrate on the health of our people.

A Stimulating Blog

2009-10-05T10:18:00.000-07:00

Recently I saw a patient who was over-treated with pharmaceutical drugs. She was on amphetamines and thyroid hormones to pick her up in the morning (she originally complained of fatigue) and sedatives and sleeping pills to bring her down in the evening.

Not surprisingly, this regimen only aggravated the fatigue and on top of it, it created a dependency on questionable and potentially addicting prescription drugs, which is quickly becoming a national problem. The latest disturbing report I saw about this was on CNN news the last week of September 2009. College students are popping Adderall, an amphetamine-like stimulant often prescribed for ADD, like it’s going out of style.

No doubt the diagnosis of ADD is legitimate in many patients, but, some practitioners use said diagnosis on practically any patient with the slightest fatigue or depression symptoms in order to justify the use of this questionable drug. Not infrequently, these practitioners justify this practice by arguing that “the patient wanted me to prescribe the drug.” Such self-deception requires no retort.

Please, do not fall for the indiscriminate use of thyroid hormones when the laboratory shows normal levels. Have you been told that the lab is not indicative of thyroid dysfunction? If you follow that logic, we would need to put everyone on thyroid hormone. The same applies to sex hormones, which are also abused, since they are also stimulants and have other steroid-like effects that in the long run end up overpaying the fiddler. HCG is another example of this irresponsible prescribing.

If you are presently victimized by any of these modes of practice, I hope you seek help from a responsible caregiver who will try to find the root of your health problems and get you off “the candy.”

Why Health Care Reform, In Any Form, Will Not Fix the Problem

2009-09-29T13:26:00.000-07:00

Utah Senator Bennet came to speak to the Utah Medical Association when doctor delegates like me met in bucolic Midway, a little town outside Park City in September 2009. Before he started his address, delegates were given a chance to voice their opinions about health care reform. Fortune had it I was the last doc to take the open microphone.

I cited evidence published in leading medical journals (see “Newsletter”) that we could literally cure 80% of chronic diseases and prevent 66% of cancers with dietary changes alone. This would translate into substantial savings that would redefine the health care problems we have and make 100% universal coverage affordable, simple and much more rewarding for all involved. Instead, we continue to argue about how to best finance a broken system that seeks to continue financing expensive, inefficient practices that focus on treating symptoms, not the root of diseases. Said system is exactly what Big Pharma and Insurance companies prefer, since it keeps them in business.

A smattering of applause followed my remarks.

Then, Senator Bennet took the stage.

I liked him immediately. He struck me as a wise old man with a great sense of humor who is able to see the good in his opponents’ proposals and ideas. In fact, he has gotten in trouble with Utah’s far right Republicans who do not like his bill offering universal coverage, even though it does not have the Right’s dreaded Public Option Plan.

His partner in crime, co-sponsor Democratic Senator Wyden from Oregon is himself in trouble in his state because Democrats there would like to see the Public Option Plan take effect. Both Senators have recruited an equal number of Senators on both sides of the aisle to support their health care proposal. And most telling, Senator Bennett has upset many Republicans for supporting President Obama on several issues.

Senator Bennet is a centrist moderate, exactly what we need for our country to stop bickering along extremist party ideologies.

This is one of the reasons why I was very pleased to hear him say toward his concluding remarks, that whatever we do in health care reform will likely not work, (paraphrasing), “because we have a dysfunctional system that focuses on treating symptoms, instead of addressing the factors that lead to disease: we are trying to reform a ‘Disease-Care System.’”

Health Scare Tactics

2009-08-26T08:40:00.000-07:00

My patient S______ was one of my best friends. We shared the same birthday and much more. S______ lived alone in a local residential care facility for seniors. I was not aware of any other visitors other than myself. She felt I was like a son to her. Often, she patiently listened to my personal struggles, giving me motherly advice and understanding. I enjoyed hearing about her memories of youthful exuberance and experiences, like watching the Enola Gay take off on its fateful doomsday mission from a base in the Utah desert.

S_____ ’s last days were not too much fun for her. Her family chose to ignore my recommendation to let her live out her last few months in peace. As a former Hospice Director I am familiar with relative’s struggles at this critical time in their loved ones lives. Their decision to drag S______ all over Salt Lake City (it was painful for her to get around) to see a handful of expensive specialists for a second opinion was understandable, especially when they seldom came to visit her. But, was it necessary, or wise?

S_____ suffered from multiple organ failure. Her heart, kidneys and lungs were barely keeping her alive. I had been treating her conservatively with a high dose water pill, narcotics and oxygen. She was comfortable and even looked forward to joining her beloved husband, whose smoking was the principal reason for her health troubles. After approximately $20,000 worth of testing and doctors’ fees, the recommendations for aggressive dialysis and more drugs thankfully fell by the wayside, yielding to common sense. S_______ was able to enjoy a few weeks of peace before she finally passed away.

I am afraid that S_______’s story is all too common… and too expensive. Roughly 40% of our health care expenses are wasted on misguided and often guilt-driven trips like S______ ‘s that cannot avoid the inevitable. Yet, it seems like an attempt to stop this madness is viewed by some as “death panels.”

While not spending enough to comfort our loved ones’ suffering at the end of life is just as reprehensible, cooler and more mature minds must prevail to strike a happy medium. After all, soon, it will be you and me in S______ ‘s slippers.

In my opinion, there are many other outright lies being thrown around in the health care debate raging in our country.

Please, keep you eye on the ball: we need to help alleviate the suffering of millions of Americans, some of whom get very little health care, if any (compared to S_____ getting too much.) We must not be blinded by the ideology and self-interests of the “man behind the curtain.” Insurance companies and Big Pharma have a nasty habit of planting misinformation designed to confuse Americans. These institutions, which originally set out to do good now are focused on doing well. Remember the controversy over Canadian drugs? Well, it was fueled by Big Pharma: Canadian drugs are safe and cheaper and will continue to be so, unless we wise up and put people first, ahead of corporate interests.

The British are upset that the debate in our country vilifies their beloved health care system.[1] So are the French and Canadians, who view our scare tactics to brand change as “communist” as a moral outrage. I agree.

Lest you think I am spewing partisan politics, let me say that I find President’s Obama’s secret meetings with the Insurance companies and Big Pharma reprehensible, albeit predictable. By now you may have heard that deals have been struck with the big boys to assure them that their profitability will be maintained.[2] While I understand Free Enterprise and profits (I love Adam Smith) I feel they must never be at the expense of our community’s health.

Mr. Obama’s pragmatism is understood and even necessary. No doubt the final draft of health care reform will include provisions to keep big business happy. But, let us not lose tract of some simple facts:

A Public Plan Option will not discourage competition. How could it? Have you not seen the massive negative response from those who feel any government-run program is of the devil? Surely most of those Americans will choose not to join such a plan, just like many of them never use the US Post Office (which continues to hemorrhage money, unaided by the Feds,) preferring Fed Ex. Surely most of them also don’t use public schools or public parks, preferring private schools and open spaces within their gated communities. Excuse me if some of that opposition does not enjoy those affluent perks; I often wonder why people oppose any program that would expand their choices and services. Many seem to defend the interests of those who already have it made in the shade. I will continue to wonder, even though I know the answer: “keep the government out of my life.”
The government is already involved in Health Care. The “single-payer” systems called Medicare and Medicaid have overhead expenses estimated to be less than 5%, while the “better run” private insurance companies’ overhead is anywhere from 15-30%.Very few doctors choose to participate in those programs. Doctors will not go for any system that threatens to “employ” them; a Public Option Plan would not. The government is already deeply involved in private insurance, too. This is the only reason such a dysfunctional system works at all. If left to their own devices, the big boys would do even more antisocial things, beyond their cherry picking healthy patients and denying payments. The present employer-based coverage is possible because of government intervention: tax breaks make it workable. By the way, I feel this is a mistake; it hinders competition and burdens a vital sector of our society with the moral obligation we should all be shouldering.
Health Care rationing will always be part of any system we choose. It would be naive to think otherwise. Right now we choose to ration health care by leaving out in the cold 47 million Americans. Other countries choose rationing by covering the most essential of services for every citizen, and leaving “boutique care” uncovered or delayed by a “waiting list.” Such care is still available to those who can afford it, and/or are able to wait for it Those “communist” systems spend half of what we spend on health care, yet, they lead the world in health care parameter like longevity. Their citizens are more satisfied with their imperfect systems than we are with ours.
“Follow the money.” We must recognize that our national preference for a capitalistic system will always result in “shadow governments” by wealthy, amoral elitists who cannot fathom extending a helping hand to those who suffer. While I agree we need to avoid a “welfare state,” we cannot morally or economically afford to deny essential necessities to the less privileged segments of our society. Let us not be so naïve to think that only one political party is in the elitists’ pockets: they both are. For instance, “blue dog” democrats who oppose a Public Plan option have been documented to get significant financing from Big Pharma.[3]
There will always be dissatisfaction. When we choose “guns over butter” we must live with our choices (see “rationing” above.) The only reason most Americans seem to be satisfied with the present system is because of government intervention in regulating the insurance companies. “If you currently have decent health care insurance, thank the government.”[4]
No health care reform will work, unless we shift our focus away from expensive, inefficient and ineffective treatments. We must focus on preventive services (like nutrition) that work on the root issues, not the symptoms.[5] Read my previous blog.
We should have never abandoned the “not for profit” model of health care. Health is not a business; it is the moral obligation of healthy, mature societies who are able to balance profits, business with healthy governments that are not in the pocket of special interests. In my home state of Utah, health care used to be in the hands of churches; what a sad day when their mercy, compassion and “communist” thinking gave way to business-run health care…
We face a moral issue, not a business issue. Please, keep this in mind as the debate rages.

[1] PBS.com, August 14th 2009
[2] J. Business Week August 11th 2009, cover issue & Salt Lake Tribune, August 13th 2009.
[3] New York Times, August 2nd 2009
[4] Paul Krugman, New York Times.
[5] “Promoting More Conservative Practices,” JAMA 2009;301:865

Health Reform from Utah: We Must Focus on Health, Not Disease

2009-08-17T09:09:00.000-07:00

"The following is a wonderful statement put out by a committee organized by the State of Utah to reform health care. I was privileged to be part of this committee." - HR

THE CRISIS BEYOND THE HEALTH CARE CRISIS
A Challenge and a Declaration

There will still be an enormous crisis in the health of Utahns and the rest of the Nation even if any existing health care reform plan in the United States is fully implemented and funded. No amount of money being poured into the health care system as envisioned in any current plan will generate the healthy individuals, families and communities in Utah and the Nation that we all aspire to achieve. Obesity, lack of fitness, poor nutrition, at risk behaviors and low coping skills for dealing with stress and social and emotional issues are not adequately targeted for reform. Without these factors being more fully addressed, the continued effort to increase services will eventually bankrupt the system, and leave the population remaining unprepared to take adequate personal responsibility to improve their own health. There are powerful evidence based approaches for supporting people to become more responsible for and successful in achieving improvements in their own health and well being. These types of knowledge, support, and culture should be embedded in the very fabric of our communities as well as in the health care system. With proper support the innate capacity for personal wellness increases, and with it, the tendencies towards greater individual and collective resilience can be seen. In addition there is a complementary science and art for creating healthy communities which generate a flourishing of society that is greater than the sum of the healthy individuals within it.

Unleashing these capacities in our communities should comprise up to half of the health care reform equation because this approach would create healthier communities, greater individual health and well being, be sustainable and effectuate reduced demand of health care services. Unfortunately wellness self management and healthy communities currently receive perhaps one percent of the attention in health care reform and less than that of the available funding.

Representatives of virtually all of the groups in Utah working on wellness self management including those involved in private sector programs, public health, health provider groups, and research convened in a summit meeting in Salt Lake City to begin to collaborate. They achieved perhaps for the first time universally shared Consensus Principles in this area, identified many best practices for evidence based approaches, and agreed on a common phrase for their shared work: pursuing healthy communities through “wellness self management.”

They have formed the Healthy Communities Wellness Self Management Network. The HC WSM Network will first of all be attempting to change the narrative around health care reform and bring attention to this “crisis beyond the health care reform crisis.” It challenges the people and leadership of the State of Utah to come to better recognize their own capacities for welness self management, the creation of healthier communities and for all of us to better come to grips with our own responsibilities in this regard. The Network is also becoming an active learning community, interconnecting existing programs and projects. It will support new demonstration projects and public policy which reflect Consensus Principles and evidence based approaches to wellness self management and healthy communities.

The people of the State of Utah are invited to join with members of the Healthy Communities Wellness Self Management Network and endorse the following Declaration:

DECLARATION
IN SUPPORT OF
HEALTHY COMMUNITIES WELLNESS SELF MANAGEMENT
AS A MAJOR PART OF
HEALTH CARE REFORM IN UTAH

Whereas, we pride ourselves in Utah on our spirit of self reliance and personal responsibility as well as our strong sense of community; and

Whereas evidence based principles and approaches of wellness self management and patterns of healthy communities have been established; and

Whereas, health care reform in Utah and the rest of the United States to date has tended not to emphasize such principles, approaches and patterns.

NOW THEREFORE: It is hereby resolved:

It is time for us to step forward and achieve healthy communities and wellness self management in Utah in a way that dramatically transcends all prior approaches to health care reform and unleashes our individual and collective capacities for creating the healthiest people and communities in the Nation and the World.

In doing so, we will cooperate extensively among the entire health care system together with communities, schools, businesses and other concerned organizations to institute and extend the means necessary to achieve a significant reduction in demand for health-care services through greater individual and community-wide responsibility.

Bridging the Environmental Gap Between Republicans and Democrats

2009-08-03T08:59:00.000-07:00

Article submitted for publication in the Utah Medical Association Bulletin.

Serving as the Chairman of the UMA’s Environmental Committee has been an honor and a valuable learning experience. When I first assumed the position I thought that the data on environmental pollution and its negative effects on human health were evident, clear and irrefutable. I felt the same about the solutions to those problems.

I am certain that my passionate stance on these issues were not well received by some in the UMA membership; which is why I gradually came to understand that the data on environmental health may no be as important as the beliefs and political persuasions of those who read it and interpret it. It also became obvious that I, too, interpret environmental data through the prism of my own beliefs, political leanings and past experiences, just like everyone else.

[No doubt some physicians will disagree with the concept that objectivity may take a back seat to subjectivity in a field like ours. I can only say that being aware of these natural tendencies is the best way to maintain an evidence-based approach in our line of work.]

Gradually, I became more willing and able to re-examine the environmental data while considering my colleagues’ contrasting interpretations in mind. Consequently, I have learned to pick my battles, spend my political capital more cautiously and reach consensus more readily for the greater good. (My, I sound like a politician…) Yet, I still feel the UMA could be more proactive in environmental health issues, but I would rather march slowly with the UMA than faster all by myself.

My willingness to compromise and be open to others’ ideas has helped me conceptualize a problem I find is interfering with our mission to maximize the health of Utah citizens. In my opinion, strongly held ideologies on both sides of the political aisle are slowing down the implementation of environmental policies and regulations that have the potential to mitigate many of the health care problems we see in our state.

As a general rule, Republican doctors may be mistrustful of government regulation and Democrat doctors may demonize polluting industry and businesses while dismissing any economic compromises. While there is a grain of truth in both stances, extremist views don’t allow for a compromise that may better protect our patient’s health when it comes to environmental issues.

These are the reasons why I was delighted to come across T. Boone Picken’s plan for environmental policies in our country. Mr. Picken, a very wealthy industrialist, feels that our NATIONAL SECURITY should be the #1 concern as we contemplate energy policies that impact our environment. He agrees that we need to stop our “addiction” to oil that puts us in harm’s way from hostile oil-producing countries. But, he feels that our energy infrastructure is not ready to make the transition to non-oil sources, except for NATURAL GAS and WIND POWER.[1]

By making national security the sine qua non (or prima non nocere if you wish) of environmental issues we are likely to satisfy a justifiable concern that has arguably become a Republic issue. By focusing on wind power and natural gas we are likely to satisfy Democrats who arguably have been “greener” over the years.[2] A national security approach would also be mindful of sustainable business and economic concerns, arguably Republican platforms. Right now, fully 1/3 of our national income leaves our country to buy foreign oil. Keeping that money home would also make us stronger and less vulnerable. Since the Cold War ended by a “technical economic knock-out” (the US economically defeated the Soviets) we are seeing more “financial wars,” or Trojan horse strategies to weaken the opposition from within. China’s agenda comes to mind…

Since our oil addiction has been one of the most serious factors behind our dollar’s decline, it seems imperative to tie our energy policies to sustainable and locally produced energy sources. If push comes to shove, what would we choose: continue to send our young people to die in hostile lands to secure oil sources; or arguably, “somewhat-theoretical” environmental health data linked to an increase in the risk of chronic illness? Since said data is viewed differently by Republicans and Democrats, it seems prudent to me choosing to avoid the sure, immediate death of our soldiers (acute care) while striving to reduce the more subtle and drawn out (chronic care) effects of environmental toxins by developing natural gas, wind power, and other cleaner energy sources as their technology mature.

I hope that as UMA doctors we are able to find a comparable and mutually satisfying middle ground from which to act on the emerging data on environmental health problems in our state.[3] It is our calling to do so.

[1] www.pickensplans.com, or www.tboonepickens.com.
[2] Mr. Nixon, a Republican, created the EPA. By the way, given the recent EPA’s endorsement of California’s policies on vehicle exhaust emissions (35.5 mpg and 40% better fuel economy by 2016) and several other policies through the years, the UMA’s environmental committee strongly recommends that the UMA support the EPA’s general philosophical approach to reducing air pollution.
[3] www.cdc.gov/ephtracking. Go to “info by location” to find Utah’s page.

Integrative Thoughts on Health Care Reform

2009-07-22T11:42:00.000-07:00

Debate on health care reform is raging along predictable party lines. You are probably waiting for me to express the slightest leaning to the left or right to quit reading.

Such polarization of ideas is only hurting dialogue and paralyzing our country into inaction. While it is true that a free society needs to have opposing views to reach a consensus or compromise, I am afraid that the divisions among us are fostering resentments, misinformation and outright hatred that go beyond a healthy exchange of ideas.

So that you relax, I have to tell you I am an incorrigible fence-straddler, forever attempting to mix polarizing ideas to reach a middle ground that is often a lonely place that most shun as “lukewarm” from their entrenched extreme views.

I advocate a heath care system much like France’s or Germany’s: a mixture of what Democrats and Republicans want, that is, a public health system and a private system that cover everyone while satisfying economic and ideological realities.

Those afraid of socialized medicine, those who quote the horrors of “rationing” allegedly seen in Canada and England would be reassured that their capitalistic ideas would be preserved. People who want more than what the government would offer, which would be rationed health care, may supplement their coverage out of their own pockets through private insurance companies. We already do that with public schools, the post office, transportation, etc.

But, maintaining that a straight capitalistic solution, without government intervention is enough ignores the results of the Massachusetts’s experience: their costs have gone up 33% trying to cover people the old-fashioned way.

My interest in economics has led me to Adam Smith’s “Wealth of Nations.” His brilliant writings were a mix of Capitalism and Social Welfare, a fact you may study yourself. So, any proponents of Darwinian Capitalism may need to temper their passion for the “invisible hand’s” infallibility. Smith maintained that said hand needs to be tempered by government regulation. Check it out.

Besides, fixing our health care system is also an economic imperative; health care is now 16% of our economy and a significant drag on competition in those industries where foreign workers get nationalized health care. Ignoring these economic realities because of fear of European Socialism is not a realistic or constructive way to deal with these economic realities.

You may want to read “Going Dutch,” an excellent article in the New York Times magazine May 3rd 2009 (no doubt I just lost those readers who feel the Times is a communist paper.) The author spent some time in Amsterdam, where he realized that the Dutch health care system is an integral part of their society, even a perfect reflection of their way of thinking. After the initial shock that any isolationist American is likely to suffer, he warmed to the system and to European Capitalism. His ideas are worth studying. Please, take to time to do so. Essentially, the Dutch never lost what we initially had in our own country: benevolent health care administered by churches who gave freely, gladly, efficiently and rejoicing in the opportunity to serve our fellowman. The Dutch never turned health care into a business like we did. Can we honestly say we got a better system after we did away with benevolent care?

Some feel that there is nothing wrong with the quality of health care in America; they even maintain that health care in the USA is the best there is in the world. I wonder how they can dismiss the statistics that show the USA dead last in the developed world in practically all categories of health care, including longevity and infant mortality.

Just about all the industrialized countries that rank at the top of health care delivery have National systems of health care; and just about all of them spend half the money we do while providing better services. Our main problem seems to be the waste inherent in our system. About 33% of our health care dollar goes toward unnecessary services and/or those that have no proven value, except in the minds of those who perceive health care as a commodity to sell just to increase profits. A significant portion of health care services has never been proven to be of any benefit at all (J. Business Week May 29th, 2006.) Yet, we continue to do procedures like back surgeries and many other invasive interventions that have been roundly questioned.

It seems naïve to believe that the rotten culture of Wall Street never affected our Corporate Health Care industry. In my opinion, “profits at any cost” has long been the motto of those in charge of said industry. While “the business of America is business” will always be deeply woven in our culture, this does not mean that we cannot do business with a little more compassion.

Unfortunately, anyone trying to point out these facts is said to be some kind of socialist out of touch with the reality that socialism was defeated in the cold war. This argument is often followed by another mantra: Canadians and Brits hate their rationing socialized systems. While there are widely publicized horror stories in those countries, it turns out that 73% of Canadians and Brits are happy with their system, compared to 56% of Americans. Still, the French and German systems are better; they are the systems I feel we need to emulate.

I am afraid that “rationing” is the dirty word that public health proponents need to be more open about; that is exactly what a public health plan would be and we need to be upfront about it. But, before condemning rationing, let me ask you a question: would you spend $10,000 in the twilight of your life if it meant an extra 6 months of life? How would you feel if the prize tag was now $100,000? Or $1 million? How about 10 million? Surely you will concede there is an amount that will not be worth spending for those extra few months of life.

Public Health Care systems do indeed ration some services, especially at the end of life when about 1/3 of money is spend (at least Medicare does.) If we had a dual system (public and private) the wealthy could still buy those 6 months of life on their own, while those who choose the Public alternative would have to content themselves with a more streamlined, leaner system; but one that would provide essential, basic services to all citizens.

Mature societies realize that rationing is necessary in a world of finite resources. Mature societies don’t need to hide this fact. On the contrary, they are open about it because they view death as an integral part of living, without the adolescent angst that is so common in materialistic, younger societies. A frank discussion with a wise and caring doctor in the waning months of our lives has shown to significantly lower the utilization of unnecessary, expensive and often heroic interventions that leave everyone dissatisfied, but those who make money on the procedures and interventions foisted on the dying fearfully.

Mature societies are well aware of the opium of the people: “Bread and Circus.” Give any society plenty of cheap, subsidized food or “Bread,” (think of junk/fast food) and plenty of cheap, mindless entertainment, “Circus,” (think of reality TV, tabloids, etc) and it is easy to see why any discussion on end-of-life care and rationing becomes a tool to plant fear in the hearts of “health care consumers.”

Many of the very people who stand to benefit the most from a public health care system buy into the rhetoric that seeks to perpetuate the status quo. They often support and repeat the corporate agenda that seeks to protect their corporate interests, not the interests of the people. Bread and Circus is a well proven Roman principle. In my opinion we would do better to focus on another Roman principle: “Salus Populi Suprema Lex,” or “The Health of the People is the Supreme Law of the Land,” not the protection of our financial or insurance corporations, as important as they will always will be. But, make no mistake: their honor, greatness and power come from serving people, not the other way around.

These corporations are afraid that they may not be able to compete with a public health care system. I don’t agree with this argument. First of all, Medicare has not driven them out of business. They will always count with the support of all those who are afraid of rationing and afraid of anything related to government. Those who cannot accept the fact that corporate insurance companies have a 15-20% overhead cost, compared to 5% by Medicare will always do business with the corporate status quo. They will always have the support of those who continue to profit from the mess we have now.

The future of health care lies in maintaining people healthy with simple, cheap interventions like teaching them nutrition, healthy and simple lifestyles that are sustainable; in other words, prevention. This cannot be done by those who focus on maintaining disease and selling costly interventions that seldom bring the expected relief they are marketed for. Chronic health care delivery can only be provided by those who understand that health is something we teach patients to maintain through healthy lifestyles, instead of fear-driven selling pitches to get health from a bottle of pills or a surgical suite.

I dream that someday the incentives and reimbursement mechanisms will favor those doctors and providers who toil endlessly and with poor recognition or reward while trying to change toxic lifestyles one on one in their busy practices They do so while fighting the so-called-paragons of service, the insurance companies, for every little bill; reams of paper work are mindlessly filled trying to justify meager minutes and pennies spent trying to provide health care services in the trenches, while those who perform expensive procedures costing thousands of dollars have no trouble “doing business” with insurance companies.

I dream of a time when medical students will have a strong economical incentive to choose primary care, instead of high spending specialties. Today 20% of them choose primary care; we need 80% of them to make that choice. They will not, until it makes economic sense to do so. We cannot expect all of them to choose primary care out of a “calling to serve.” It would be nice. But consider your own motivation in choosing your career before ignoring economic realities in their expensive education that leaves them saddled with astronomical student loans.

Only a health care system that dares question the corporate culture that has gotten us where we are today can have a shot at healing our malaise. But, we cannot do this unless we retain the “business” side of health care as a real choice for those who want top of the line, un-rationed health care to be paid out of their own pockets, especially when they have worked hard to earn higher incomes.

Medical Biases

2009-06-30T14:03:00.000-07:00

I recently attended a review course to prepare for the Boards. For 4 straight days we started at 7 AM and finished at 9:30 PM. This intellectual boot-camp took place in Vegas, but the only fun thing I got to do was eat dinner by myself at the Paris buffet; a Japanese tourist and I were the only ones loading up on the veggies and sushi.

The course itself was brutal, but a great way to prepare. Interestingly, a couple of presenters epitomized the state of affairs in non-pharmaceutical medicine; one continually railed against the misguided over-reliance on many virtually ineffective pharmaceutical treatments, while the other reluctantly discussed some herbs and nutrients that have significant evidence and efficacy.

The latter doc warned that the evidence was thin and that there were significant side effects with those natural items. Yet, this presenter did not do likewise when it came to drugs. For example, black cohosh, approved for use in menopausal problems by the American Academy of Ob-Gyn, was said to be worthless and potentially dangerous. Yet, nothing was said about hormonal replacement with estrogen, which has been shown to increase the risk of cancer by the NIH since 2002.

Amazing: estrogen is OK, yet poor little black cohosh, which has never been associated with any cancers, is not.

What is really going on? It is simple; let me illustrate with another example:

Initially it was reported that hip padding/protectors did not reduce the risk of hip fractures in falls sustained by the elderly. Later, it was shown that they DO INDEED reduce the risk of hip fractures by a whopping 50%. It turned out that one of the authors of the negative study had not disclosed his financial ties with hip replacement surgeries.

“Follow the money.”

It is extremely naïve to deny the fact that our beliefs do not influence our intellect.

PS, I do not sell non-pharmaceutical products. Occasionally, I speak for companies that do.

Still around…

2009-06-08T09:13:00.000-07:00

Sorry I have not had time to blog.

I have been too busy studying for my Family Practice Boards (every 7 years.) It’s quite an ordeal for me; I have to memorize a lot of stuff (excessive pharmaceutical treatments taking precedence over nutritional, environmental and emotional issues) I don’t emphasize in my practice.

Nevertheless, I must remain up to date for many reasons, one of which is to get reimbursed by insurance companies who continue to dismiss the fact our practice saves them thousands of dollars, even though they have seen the future of health care; more social responsibility.

They are a bit concerned that their golden goose is threatened. Surely you saw right through their attempt to appear cooperative when the met with Mr. Obama last month at the White House, only to later oppose the plans to start a Public Health Insurance. Despite the plan being proposed to increase competition, a word they love, they fear they will be left in the dust.

If they truly believe in competition they would welcome the proposed addition. Perhaps they fear that, just like Medicare, the new plan will have a much lower cost due to lower overhead costs (more efficiency,) like Medicare; that is 5% compared to their bloated 15-25% overhead.

But, back to the Board Exam (next month.)

It turns out that this time around the exam-makers have finally added questions on non-pharmaceutical treatments; the evidence for some of these treatments cannot be denied any longer. They are asking doctors to bone up on treatments like:

Saw Palmetto: prostate problems
St John’s Wort: depression
Bilberry and other antioxidants: macular degeneration
Feverfew: migraines
Omega oils: heart and many other conditions
Sulfur: bladder
Vitamin D: osteoporosis, insulin resistance
Acetic acid, mineral/olive oils: ear canal infections
Capsaicin (red peppers:) shingles, burning mouth syndrome
Glucosamine: bones

Even though this is a very shy list, it is the first time my board exam includes this sort of things. I am sure the list will get longer. Maybe it will even be halfway decent by the time I retire….

Vaccine Fights

2009-03-05T12:19:00.000-08:00

Not a clinic day goes by without a worried mom asking my opinion on vaccinations. They are confused and afraid to do anything that may harm their children. I feel badly for them, victims as they are of mixed data on vaccinations and extreme positions taken by doctors who refuse to admit that there may be significant problems with vaccines and those who advocate that vaccinations are of the devil.

To those moms who are contemplating avoiding vaccinations altogether I tell them that this is not a good idea; our society would again be ravaged by deadly diseases we have forgotten about, like diphtheria, polio, measles, etc. If we lived in a perfect world without stress, overcrowding, unpolluted water and food we might get away without vaccines.

As an imperfect practitioner of the “middle way,” I decided early in my career that such a contentious issue cried out for a compromise until we came up with more rational and clear guidelines that would include not only hard data but the feelings, intuition and wishes of mothers who often get their children’s health issues right before the medical profession does.

Consequently, I have been sticking my neck out advising moms that they could delay immunizations until one year of age to wait for their children’s immune system to mature; then spread out the vaccines. Instead of blasting them with so many shots and challenges to their forming immune system, they could do one vaccine every other month, provided they feed their infants well (no sugar and trans-fats) and keep them out of day care centers.

I did just that with my own daughter who is now 8 years old. So far, I have seen not one case of health issues that might be blamed on this schedule of vaccinations or alleged side effects.

You can imagine my delight when I saw the report in the Salt Lake Tribune (March 4th 2009) reporting that many doctors are asking that the current schedule be reviewed; specifically, the timing and spacing of vaccines. Dr Sundwall, the Utah Department of Health director, Dr. Pavia, the chief of the Pediatric Infectious Diseases at the U. of Utah School of Medicine and 25 other doctors in Utah have expressed their opinion to the upcoming meeting of the Vaccine Advisory Committee in Washington DC later this month.

While most of these doctors are betting that the present schedule is safe, the fact that a dialogue is taking place is encouraging. Some of them apparently believe that the CDC statement that there is no link to health problems like Autism, while supported by present data, has not reassured many mothers who feel that the issue is far from settled.

I side with these mothers. Let us be as safe as possible, until the issue is settled to everyone’s satisfaction. I am afraid that economic interests have clouded the data, which happens too often when profits are to be had, even in the health care field.

Drugs Down the Toilet

2009-03-02T15:27:00.000-08:00

(Submitted for publication in the UMA Bulletin; I am an Editorial Board member)

“They have found that a lot of prescription drugs are turning up in our drinking water. People not only pee drugs into in the toilet but they also dump the unused prescriptions in it. They have found hormones, antibiotics and many other kinds of drugs. Depressing news, don’t you think? Don’t worry about it: drink the water; it also has antidepressants and xanax.”

Funny. Not funny. But Leno is right.

Articles like “Drugs Are in the Water” have documented that a significant number of fish in the Potomac and its tributaries are hermaphrodites. Feminization is seen with drug concentration as low as 5 part per trillion. Fish swim in waters where 10+ pharmaceuticals have been detected. Every bluegill, black crappie and channel catfish had levels of antidepressants. A survey of 139 streams showed that 80% contained prescription drugs and fragrances, sunscreens, etc. They survive biodegradation and wastewater treatment.

An AP study showed that most drugs are metabolized only 80% which explains why antibiotics, antidepressants, anxiolytics, anticonvulsants and hormones re found in the drinking water of 41 million Americans. Twenty four major metropolitan areas were surveyed. Philadelphia had 56 types of drugs in its water. Unfortunately, this type of study is rarely made available to the public.

The problem is sure to be widespread since no tests are available to look for the problem. The EPA doesn’t know what to make of the whole thing: “a few parts per million of drugs in the water may or may not be a problem.”

I feel the problem seems obvious but we may be aware of only the tip of the iceberg; the effect of combinations of these chemicals and their additive/synergistic effect are not known. For sure we are seeing more antibiotic resistant bacteria.

In view of this pressing issue the Environmental Committee is contemplating bringing this issue to the floor of our upcoming House of Delegates meeting this year. Your input is welcome; we are not sure what measures we could take as doctors. But, in the meantime we encourage you to visit: http://www.medicationdisposal.utah.gov/disposal_locations_events.htm for a list of places where our patients could drop off unused prescriptions (police stations and pharmacies.) Perhaps we could display said list prominently in our clinics. Maybe we could insist that all pharmacies do likewise. While we cannot tell patients to cross their legs and not pee, we could become more conservative in our prescribing habits.

The JAMA on Drugs

2009-03-02T14:45:00.000-08:00

(Submitted for publication in the UMA Bulletin; I am an Editorial Board member.)

“Overdosed America” is a book by Dr. Abramson that documents how doctors are prescribing too many drugs. The Journal of the American Medical Association published an article on February 25th 2009 agreeing with the good doc.

Before you assume that I am blaming doctors let me say that in my opinion they are mostly victims as much as the patients who receive our prescriptions. Of course we all share a bit of the responsibility for the drugging of our society. Doctors have not made a significant effort to learn to treat the roots of diseases (nutrition, environment and Mind-Body-Spirit issues) and patients have grown to expect a pill to manage their every little symptom.

Doctors may excuse themselves by saying that their patients’ genetics are so strong that nothing will change their patients’ tendency to develop a given disease. This is an indefensible position when we study the fields of nutrigenomics and nutrigenetics; yes, nutrition does modulate genetic expression. In fact, toxic environments and relationships also modulate genetic expression.

Patients may excuse themselves by saying it is too hard to change their lifestyle (an opinion shared by most doctors); they just want the latest pill they saw advertised on TV. In fact, in my own practice I have seen patients who feel I don’t listen to them because I don’t prescribe them the latest drugs advertised on TV for their symptoms nor thyroid and sex hormones, amphetamines and the newest psychoactive medications to help them lose weight. Rather than listen to my advice to change their diets, detoxify their environments and their relationships they find a practitioner next door who will eagerly pull out his/her smoking prescription pad.

For these and many other obvious reasons I rejoice in the JAMA’s courage to publish the article “Promoting More Conservative Practices.” So that you rejoice with me I am herein quoting from this article. The implications of the following statements are enormous:

• “Although medical and pharmacy curricula and journals are rich with information about drugs and treatment of specific diseases, there is a paucity of education on ways to become effective lifetime prescribers. Two recent reports from the Association of American Medical Colleges (AAMC) lamented the current state of pharmacology teaching and the disturbing extent of pharmaceutical industry influence at all stages of medical education. Given the well-documented prevalence of medication-related harm and inappropriate prescribing, such educational reform is necessary but not sufficient to ensure that patients are optimally treated… trainees need guiding principles to inform their thinking about pharmacotherapy to help them become more careful, cautious, evidence-based prescribers.”

• “These lessons are fundamental for teaching clinicians how to develop excellent prescribing skills, yet such fundamentals are absent or underempahsized in current medical pharmacy education… they also need to be taught a set of skills and attitudes that will help them approach claims for drugs, especially new drugs, more critically.”

• “Without a more cautious and more skeptical approach to using drugs, prescribers will lack the will and the skills to resist ubiquitous promotional messages encouraging them to reach for newer and often more expensive medications.”

• “Although the attitudes and behaviors recommended in our principles [see box below] should not be terribly controversial, taken together they represent a departure from current practice.”

• “From the founder of modern medicine Dr Osler to leading pharmacology textbooks, taking a more skeptical and conservative approach to pharmacotherapy has a long and honorable history in medicine… Rather than therapeutic nihilism, the approach of these guidelines aims to better respect the limitations of knowledge and more closely align clinicians with the interests of patients.”

Many doctors reading this article are dedicated to these simple principles. While not perfect in their prescribing I would guess they strive to follow the old dictum “primum non nocere” (first do no harm) to the best of their abilities.

Of all the recommendations in the box I would like to emphasize the first 3 under “think beyond drugs.” Many doctors reading this article no doubt have had these simple principles and their desire to implement the best ways to heal patients as the driving forces behind their pursuit of research highlighting nutrition, environmental issues and the Mind-Body-Spirit connection. In my own experience, applying the references I have found in our leading medical journals have helped me avoid and/or stop 80% of the prescription medications commonly used for chronic ailments, a figure that Dr Willet at Harvard Medical School has also documented.

More evidence

Interestingly, the same issue of the JAMA had related articles on how clinical practice “guidelines” are influenced by marketing more than hard evidence and how the “FDA exerts too little oversight of researchers’ conflicts of interest.” The article on the controversy surrounding the cholesterol lowering drug exetimibe/simvastatin is a good example of how prevention and nutrition are seldom part of serious discussions on treating heart disease.

The New England Journal of Medicine last month had an article along the same lines, “The Neurontin Legacy: marketing through misinformation and manipulation.” Before tackling the well-known drug neurontin/gabapentin, the article opens up by reminding us of the shady deals that allowed synthroid-makers to hide evidence that the generic levothyroxine is just as good. Then, it gives pointed examples and direct quotes from pharmaceutical executives who pushed their representatives to drive up sales by hyping neurontin to doctors. The drug reps claimed the drug had benefits that were never shown in their internal research.

The author feels that “drastic action is essential to preserve the integrity of medical science and practice and to justify public trust” and that the public and doctors need “public funding of peer-reviewed pharmaceutical research through a National Institute for Pharmaceutical Research that might be funded by a tax on all drug sales.”

I am sure you will agree with his final conclusion:

“Will our profession soon feel compelled to advocate for such actions to preserve our integrity, our social contract and ultimately our privileges?”

Perhaps the article in the same issue of the NEJM may help us shed some light on the “man behind the curtain:” “Money and the Changing Culture of Medicine.” Again, the article’s implications are so enormous that I choose to only quote from it:

This is the title of a remarkable article in the top medical journal in the world Here are its main points:

• “Assigning a monetary value to every aspect of a physician’s time and effort may actually reduce productivity, impair the quality of performance and thereby increase costs.”

• “Even the suggestion of money promotes behavior marked by selfishness and lack of collegiality.”

• “Medicine has marketplace elements that are inherent in any business-a physician receives payment for services. But there is also a communal relationship, an expectation and obligation to help when assistance is needed. In the current environment the balance has tipped toward market exchanges at the expense of medicine’s communal dimension. Many physicians we know are so alienated and angered by the relentless pricing of their day that they wind up having no desire to do more than the minimum required for the financial bottom line.”

The journal feels that the answer is “Patient-centered medical home,” or a “compassionate partnership…. [where] the insurer would pay a set fee for each patient cared for in the medical home to cover what is now not reimbursed time.” In my opinion this means that doctors would now have an incentive to learn about nutrition and motivational techniques to help patients change their toxic lifestyle. This would lead to more emphasis on prevention and a significant reduction in the cost of health care.

“Caregivers should be appropriately reimbursed but should not be constantly primed by money. Success in such a model will require collegiality, cooperation and teamwork-precisely the behaviors that are predictably eroded by a marketplace environment.”

The bottom line is money.

As the economy continues its downward spiral I cannot get enough reading in Economics. The last book I read was Wealth of Nations by Adam Smith (1776.) I highly recommend it, if you are willing to speed-read through the boring parts. The two things that struck me the most was his common sense and wisdom and how both sides of the political/economic spectrum misquote him to justify their own ideologies.

The supply siders (Republicans) emphasize how the invisible hand is going to take care of practically every thing while the demand siders (Democrats) emphasize government regulation. It turns out that Adam Smith wrote that both are necessary: business can only thrive when the law efficiently protects the right of business people to seek profits, but with the limitations necessary to respect labor and the land.

One thing is certain, says Adam Smith: when business people gather, they will always have the tendency to organize themselves to maximize profits even at the expense of the public. This is why regulation is necessary. And regulation of the pharmaceutical industry, particularly of their CME tactics and advertisement is sorely needed.

“The profession of medicine, in every aspect, clinical education, and research, has been inundated with profound influence from the pharmaceutical and medical device industries. This has occurred because physicians have allowed it to happen, and it is time to stop.”

Despite the clear and common sense advise from Adam Smith we will always be polarized when it comes to politics and economics. You would think that anyone interested in scientific reasoning would seek the middle ground he championed. But, it is not inherent in most people to think scientifically or objectively. This is why I enjoyed the article “On Second Thought…”

“When politicians [change their mind], they are tarred as flip-floppers. When lovers do it, we complain they are fickle. But scientists are supposed to change their minds when evidence undercuts their views. Dream on…But really, we shouldn’t be surprised. Proponents of a particular viewpoint, especially if their reputation is based on the accuracy of that viewpoint, cling to it like a shipwrecked man to flotsam. Studies that undermine that position, they say, are flawed.”

Which brings me back to us, doctors. You would think that most of us would be ready and excited to accept the scientific evidence in medical journals that highlights prevention, nutrition environmental toxins and the Mind-Body –Spirit connection. But, it seems that the scientific inquiry required to take the time is not in abundant supply. Could it be that Thomas Kuhn was right when he said that a scientific paradigm (i.e., “nutrition is a second class alternative”) topples when the last of its powerful adherents dies? Could it be that money has something to do with what scientists/doctors believe?