Tuesday, January 5, 2010

20-20 Vision Staring 2010

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into conventional medical education and practice, and the term ‘complementary and alternative medicine’ will be superseded by the concept of “Integrative Medicine…”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

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.

Monday, December 21, 2009

Doctors Weigh in on Health Care Reform

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.

Wednesday, December 16, 2009

Still Ignoring New Research on Obesity

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.

Tuesday, December 15, 2009

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

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

Wednesday, December 2, 2009

November Books

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.

Thursday, November 19, 2009

Mammogram Controversy

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?