It's raining lead!
05, 11 07, 20:35 Filed in: Medical
It seems like the cascade of lead in products on our store shelves never ends: paint, toys from China, lunch boxes, supplements from China. Now we've got another source of lead coming from right here in this country: lipstick. Of the name-brand lipsticks tested over half had significant levels of lead and a third of the lipsticks had more lead than is currently allowed to be in candy (I didn't realize they allow lead in candy...). You can read the full report here.
So, add this to the pile of sources of lead exposure and stir it with the research that came out last year showing that lead exposure at levels way below what was considered toxic increased heart attacks. How many other things does it impact? No one's done the research.
The best thing to do is protect yourself by minimizing your exposure, taking plenty of vitamin C and consider removing what lead there is with proven chelating agents.
So, add this to the pile of sources of lead exposure and stir it with the research that came out last year showing that lead exposure at levels way below what was considered toxic increased heart attacks. How many other things does it impact? No one's done the research.
The best thing to do is protect yourself by minimizing your exposure, taking plenty of vitamin C and consider removing what lead there is with proven chelating agents.
Vitamin D (again) reduces cancer risk
07, 10 07, 22:26 Filed in: Medical
It's starting to get tedious. In a recent article in the American Journal of Clinical Nutrition, Vitamin D (this time with calcium) reduces the risk of cancer (in a group of >55 year old Nebraskans) over a 4 year period by 76% (95% confidence interval 40-91%). At least they gave a useful amount of vitamin D3 (1100iu/day). Interestingly, even calcium (1500mg/day) alone showed a substantial lowering of risk, but it wasn't significant.
Now, the important thing to appreciate is that this study was only 4 years and that your typical cancer will have been growing for several years before it is diagnosed. So, is this a reduction in the incidence of cancers (less cancers starting), slowing of growth (thus fewer showing up over the study), or stopping the cancers that had already begun? Frankly, with such a dramatic improvement, it could be all three.
Now, the important thing to appreciate is that this study was only 4 years and that your typical cancer will have been growing for several years before it is diagnosed. So, is this a reduction in the incidence of cancers (less cancers starting), slowing of growth (thus fewer showing up over the study), or stopping the cancers that had already begun? Frankly, with such a dramatic improvement, it could be all three.
Phthalates, testosterone, air freshener, and fish
07, 10 07, 19:25 Filed in: Medical
What do phthalates, testosterone, air freshener, and fish have in common? They've all been topics in recent articles coming from the NRDC's senior scientist Gina Soloman. Nice source of information.
The first three all come form the same article: Air Fresheners - How Safe Are They? NRDC tested 14 air fresheners and found 12 contained phthalates, which are endocrine disrupters and alter hormone levels - particularly the testosterone levels in babies. Walgreens, whose air fresheners had the most phthalates, impressively responded by pulling the stuff off the shelf and reformulating it. Here's a page that lists the symptoms many perfume ingredients can cause as well as other things you can use to clean, and this page summarizes the phthalates issue and also tells you what you can do about it.
The other article discusses the conflicting recommendations that just came out about fish intake particularly for pregnant women. She correctly points out that the recommendations to eat fish should include aiming for low-mercury fish. At the end of the article she has several great links about the issues at play.
The first three all come form the same article: Air Fresheners - How Safe Are They? NRDC tested 14 air fresheners and found 12 contained phthalates, which are endocrine disrupters and alter hormone levels - particularly the testosterone levels in babies. Walgreens, whose air fresheners had the most phthalates, impressively responded by pulling the stuff off the shelf and reformulating it. Here's a page that lists the symptoms many perfume ingredients can cause as well as other things you can use to clean, and this page summarizes the phthalates issue and also tells you what you can do about it.
The other article discusses the conflicting recommendations that just came out about fish intake particularly for pregnant women. She correctly points out that the recommendations to eat fish should include aiming for low-mercury fish. At the end of the article she has several great links about the issues at play.
"Pharmacologic Treatment of Osteopenia Not Usually Indicated"
17, 09 07, 12:21 Filed in: Medical
A recent American Family Physician journal, citing a JAMA article, puts the lie to the idea that people (particularly women) with osteopenia (low bone density) should be on medications. With all the evidence that these medications (like Fosamax or its friends) shouldn't be first-line treatments, why are doctors still prescribing them so quickly? If your doctor pulls out the pad for this, ask them when the last time they saw that drug rep and whether they are pushing the doc to use it as a preventative. This kind of behavior is occurring more and more, so let your doctor know that it's getting so obvious and blatant that even the patients are picking up on it. There are some movement among conventional docs to limit their exposure to drug reps, No Free Lunch for practicing physicians and Pharmfree for medical students. Sadly, the No Free Lunch doesn't turn up any drug-rep free primary care physicians in Ann Arbor (though it does find a pediatrician in Ypsilanti).
Interestingly, the article points out that the only treatment that has been shown to reduce nonvertebral fracture risk in women with osteopenia is estrogen. Bioidenticals, anyone?
Interestingly, the article points out that the only treatment that has been shown to reduce nonvertebral fracture risk in women with osteopenia is estrogen. Bioidenticals, anyone?
Yield or flavor and nutrition?
16, 09 07, 21:03 Filed in: Medical
When I was in college, I brought my grandmother an organic nectarine from the co-op in Champaign. She wasn't interested, saying, "I don't like nectarines," but finally acquiesced. When she tried it, her eyes lit up and she said she didn't like the ones in the stores any more since they were flavorless, but this one tasted like they did when she was a kid.
A nice report just came out that puts together the increase in yield through modern farming with the loss of flavor and nutrients that has been dogging our foods. The bottom line is that while the volume of food per acre has increased, the nutrients per acre has not seen the same increase, so the food is less nutritious. Along with the loss of nutrition comes a loss of flavor (is it because of this that people are thought to lose their sense of taste as they get older?).
There's lots of great info in the full report, but it's 36 pages plus introduction and footnotes, so let me hit a couple important points:
•At least 30% "of the U.S. population ingests inadequate levels [by their estimation of "average requirement"] of magnesium, vitamin C, vitamin E, and vitamin A". This also means "the average American consumes inadequate levels of 2.9 [of the 16 evaluated] essential nutrients each day". This is worse in women and worse with increasing age (women 19-30 years old average 3.78 deficiencies, nearly 1/4 of the nutrients studied). Specifically, vitamin E intake is inadequate in over 97% of adult women, with the average getting only half of what she needs (note that this is vitamin E from food which is more then just the alpha-tocopherol found in most supplements). [p. 8]
•By growing new, high-yield, varieties next to older varieties, they were able to demonstrate that the significant reductions in modern crops stems from the high-yield strains: between strains used in 1873 and 2000, iron dropped by 28%, zinc dropped by 34% and selenium dropped by 36%, in addition to a decrease in the quality of the protein. This means you must eat more food to get the same amounts of nutrients. [p. 14]
•This doesn't only apply to vegetables, but to other foods as well: as milk production per cow increased, the nutrient concentration decreased. [p. 18]
•The increased transit distance of or food (averaging at least 1,500 miles from farm to plate) means most food is picked green and ripened artificially, further diminishing nutrients: ripe blueberries have more than four times the anthocyanins (cancer-protective compounds) that green picked ones do, and picking apples and apricots green leaves them with no vitamin C, which is normally contained in the ripe fruits. [p. 19]
•Increasing carbon dioxide in the atmosphere also leads to further losses in nutrients. [p. 19]
•Organic foods do have higher concentrations of nutrients that conventionally grown crops. [p. 25]
Finally, they point out that due to the higher nutrient density of organic produce, it scores higher in taste than conventional produce. [p. 32]
Score one for my grandmother.
A nice report just came out that puts together the increase in yield through modern farming with the loss of flavor and nutrients that has been dogging our foods. The bottom line is that while the volume of food per acre has increased, the nutrients per acre has not seen the same increase, so the food is less nutritious. Along with the loss of nutrition comes a loss of flavor (is it because of this that people are thought to lose their sense of taste as they get older?).
There's lots of great info in the full report, but it's 36 pages plus introduction and footnotes, so let me hit a couple important points:
•At least 30% "of the U.S. population ingests inadequate levels [by their estimation of "average requirement"] of magnesium, vitamin C, vitamin E, and vitamin A". This also means "the average American consumes inadequate levels of 2.9 [of the 16 evaluated] essential nutrients each day". This is worse in women and worse with increasing age (women 19-30 years old average 3.78 deficiencies, nearly 1/4 of the nutrients studied). Specifically, vitamin E intake is inadequate in over 97% of adult women, with the average getting only half of what she needs (note that this is vitamin E from food which is more then just the alpha-tocopherol found in most supplements). [p. 8]
•By growing new, high-yield, varieties next to older varieties, they were able to demonstrate that the significant reductions in modern crops stems from the high-yield strains: between strains used in 1873 and 2000, iron dropped by 28%, zinc dropped by 34% and selenium dropped by 36%, in addition to a decrease in the quality of the protein. This means you must eat more food to get the same amounts of nutrients. [p. 14]
•This doesn't only apply to vegetables, but to other foods as well: as milk production per cow increased, the nutrient concentration decreased. [p. 18]
•The increased transit distance of or food (averaging at least 1,500 miles from farm to plate) means most food is picked green and ripened artificially, further diminishing nutrients: ripe blueberries have more than four times the anthocyanins (cancer-protective compounds) that green picked ones do, and picking apples and apricots green leaves them with no vitamin C, which is normally contained in the ripe fruits. [p. 19]
•Increasing carbon dioxide in the atmosphere also leads to further losses in nutrients. [p. 19]
•Organic foods do have higher concentrations of nutrients that conventionally grown crops. [p. 25]
Finally, they point out that due to the higher nutrient density of organic produce, it scores higher in taste than conventional produce. [p. 32]
Score one for my grandmother.
Insurance companies reject bioidentical hormones!
09, 09 07, 21:30 Filed in: Medical
I just got a note from SaveMyMedicine.org about the latest way that insurance companies are working to help the drug companies: by refusing to pay for compounded hormones. You'd think they'd be smart enough to see that by covering compounded bioidentical hormones they could be saving themselves drastic amounts of money: Premarin or Prometrium are about $45 a month each and testosterone gel or patches are upwards of $200 a month, while compounded estrogen (usually a combination of estrone, estradiol, and estriol), progesterone, or testosterone each start at around $25 or so a month (they can go a little higher at higher doses). Add the additional costs of higher incidences of breast cancer in women taking Provera and they could really be making out by supporting bioidenticals.
Aetna's going to stop on October 1, while BCBS changed their policy back in May (note that BCBS cites an unscientific 2001 FDA study that even the FDA doesn't support).
As the note I got says: If you are an Aetna or BlueCross BlueShield customer, please contact your employer’s HR department and ask them to petition your health insurance company to reinstate coverage of bioidentical hormones and other compounded medicines. Remind them that healthy employees are productive employees and your health depends on these drugs. Your doctor has decided that compounded medicines such as bioidenticals are the best treatment option for you. Both your employer and your insurer have a responsibility to provide you with the medicines you need at a reasonable cost.
Aetna's going to stop on October 1, while BCBS changed their policy back in May (note that BCBS cites an unscientific 2001 FDA study that even the FDA doesn't support).
As the note I got says: If you are an Aetna or BlueCross BlueShield customer, please contact your employer’s HR department and ask them to petition your health insurance company to reinstate coverage of bioidentical hormones and other compounded medicines. Remind them that healthy employees are productive employees and your health depends on these drugs. Your doctor has decided that compounded medicines such as bioidenticals are the best treatment option for you. Both your employer and your insurer have a responsibility to provide you with the medicines you need at a reasonable cost.
The HBOT that just won't stop
03, 09 07, 16:51 Filed in: Medical
Alright, new there's even more stuff I've found on hyperbarics and I hate to keep it to myself. HBOTreatment.com carries a variety of mountains of info on the utility of HBO, including this article (in PDF format) on HBO for multiple sclerosis. In fact, this page is a catalog of articles on using HBO in a variety of disorders.
The AAHA (American Association for Hyperbaric Awareness) is seeking to advance the understanding of HBOT. Their website is worth a look (just be ready for the audio "Welcome!" when the page loads). The Hyperbaric Healing Institute has a few notes on using HBO for various disorders.
The AAHA (American Association for Hyperbaric Awareness) is seeking to advance the understanding of HBOT. Their website is worth a look (just be ready for the audio "Welcome!" when the page loads). The Hyperbaric Healing Institute has a few notes on using HBO for various disorders.
Carpet in!
23, 08 07, 13:18 Filed in: Office
I finally got the new carpet installed into the front and it looks pretty good. I was finally able (with the help of a patient) able to track down recycled, environmentally-friendly carpet tiles from Flor and find people who knew how to install it.
So, now the front desk is in the other room and (9 months on... hmm...) nearing completion of the remodeling.
So, now the front desk is in the other room and (9 months on... hmm...) nearing completion of the remodeling.
Even more on HBOT!
23, 08 07, 11:49 Filed in: Medical
Would you believe I got an email last night about using hyperbaric oxygen in the military for al the brain injured veterans we're getting these days? It's from the American Association for Health Freedom, who are supporting the International Hyperbaric Medical Association in seeking funding for treatment for 400 veterans. In the background info for the campaign, they include this video of a 17 year old who suffered traumatic brain injury in a high speed motor vehicle accident. After he was discharged from a rehab canter for for failure to improve, he underwent 90 HBOT sessions and made remarkable improvements. An interesting thing to note in this video is that after the first 40 treatments he only makes minimal progression, but then things start improving more quickly.
More on Hyperbarics
20, 08 07, 02:24 Filed in: Medical
Every time I read more on the utility of hyperbaric oxygen (HBOT), I'm more annoyed that it isn't being used more frequently to treat some of the things it's really good at: neurovascular diseases (MS, alzheimer's, etc.), ischemic conditions (stroke, heart attack, sickle cell exacerbations). In addition to the article I mentioned last november, I've come across a couple more: a journal article about the successes of HBOT (and the politics holding it back) and an article about the unrelenting attacks on a physician who is using it to successfully treat patients, as well as an article about the American Heart Association's demonstration that HBOT is an effective treatment for heart attack.
In fact, here's 13 benefits to the heart from HBOT (from that last article, please see it for the references):
1. Hyperbaric oxygen therapy applied to the heart during critical loss of oxygen exerts a remarkable defibrillating effect so that tremulous, rapid, ineffectual contractions are prevented; total death of the heart muscle cells is avoided; and abnormal dilation of the blood vessels with subsequent complications is controlled.1
2. Using HBOT in conjunction with various drugs enhances the effectiveness of both the oxygen and the drugs.2,3,4,5
3. Combining HBOT with drugs completely arrests or considerably reduces angina attacks in patients otherwise resistant to prolonged drug treatment.6,7,8.9
4. Patients with cardiac pain from ischemic heart disease experience total relief, along with disappearance of dyspnea (difficulty breathing), when they receive HBOT.10,11
5. Administering HBOT lowered elevated blood cholesterol in all 220 patients cited in a study conducted by the Russian internist Dr. S.A. Borukhov and her colleagues.12
6. HBOT normalized electrocardiograms in all patients in that same Soviet study.13
7. For diminished muscular power of the heart, HBO exerts long-term normalizing effects for circulating blood through the body.14
8. HBOT exerts antiarrhythmic action on the heart.15,16,17
9. HBOT increases heart patients' tolerance to hard work and taking on physical loads.18,19
10. HBO taken at three atmospheres of pressure (a pressure rarely used in the United States) protects any individual's heart from damages due to lack of oxygen.20
11. One's entire heart conduction system functions better from receiving HBO treatment (even when prophylactically administered).21
12. Without taking drugs of any kind, breathing oxygen under pressure stabilizes impaired fat metabolism and improves liver function for someone with ischemic heart disease.22
13. Due to its characteristic of mollifying stress and distress, HBO has long-term and short-term protective effects for a person with a heart problem.23
Finally, I just came across a virtual font of articles on HBOT written by Dr. R. A. Neubauer MD, including 2 articles specifically about the etiology of multiple sclerosis and the treatment of MS with HBOT (1, 2).
In fact, here's 13 benefits to the heart from HBOT (from that last article, please see it for the references):
1. Hyperbaric oxygen therapy applied to the heart during critical loss of oxygen exerts a remarkable defibrillating effect so that tremulous, rapid, ineffectual contractions are prevented; total death of the heart muscle cells is avoided; and abnormal dilation of the blood vessels with subsequent complications is controlled.1
2. Using HBOT in conjunction with various drugs enhances the effectiveness of both the oxygen and the drugs.2,3,4,5
3. Combining HBOT with drugs completely arrests or considerably reduces angina attacks in patients otherwise resistant to prolonged drug treatment.6,7,8.9
4. Patients with cardiac pain from ischemic heart disease experience total relief, along with disappearance of dyspnea (difficulty breathing), when they receive HBOT.10,11
5. Administering HBOT lowered elevated blood cholesterol in all 220 patients cited in a study conducted by the Russian internist Dr. S.A. Borukhov and her colleagues.12
6. HBOT normalized electrocardiograms in all patients in that same Soviet study.13
7. For diminished muscular power of the heart, HBO exerts long-term normalizing effects for circulating blood through the body.14
8. HBOT exerts antiarrhythmic action on the heart.15,16,17
9. HBOT increases heart patients' tolerance to hard work and taking on physical loads.18,19
10. HBO taken at three atmospheres of pressure (a pressure rarely used in the United States) protects any individual's heart from damages due to lack of oxygen.20
11. One's entire heart conduction system functions better from receiving HBO treatment (even when prophylactically administered).21
12. Without taking drugs of any kind, breathing oxygen under pressure stabilizes impaired fat metabolism and improves liver function for someone with ischemic heart disease.22
13. Due to its characteristic of mollifying stress and distress, HBO has long-term and short-term protective effects for a person with a heart problem.23
Finally, I just came across a virtual font of articles on HBOT written by Dr. R. A. Neubauer MD, including 2 articles specifically about the etiology of multiple sclerosis and the treatment of MS with HBOT (1, 2).
Who woulda thought? Folic acid is effective.
26, 07 07, 09:52 Filed in: Medical
After the incessant drumbeat coming out of the pharma-pumped media disparaging nutrition, a refreshing article came out the other day: "Folic Acid May Lower Stroke Risk." One of the key findings is that there are greater improvements in risk in the people who took it longer. This is, of course, obvious, since you can't expect to starve yourself for months then have a good meal and be right back to normal.
Of course, in order not to lose her professorship, dr. Carlsson (who is quoted in the article) has to say that it is premature to recommend a benign and inexpensive nutrient to prevent strokes in the population that shows the greatest reduction in stroke risk from folic acid supplementation (people who've never had strokes, "primary prevention").
Dr. Wang (one of the researchers) suggests that "people in the U.S. who eat healthy diets probably get enough folic acid in the foods they eat." Any guesses what fraction of the population would fall in to that category?
Of course, in order not to lose her professorship, dr. Carlsson (who is quoted in the article) has to say that it is premature to recommend a benign and inexpensive nutrient to prevent strokes in the population that shows the greatest reduction in stroke risk from folic acid supplementation (people who've never had strokes, "primary prevention").
Dr. Wang (one of the researchers) suggests that "people in the U.S. who eat healthy diets probably get enough folic acid in the foods they eat." Any guesses what fraction of the population would fall in to that category?
Most Americans obese by 2015?
21, 07 07, 23:16 Filed in: Medical
Epidemiologic Reviews just came out with news that not only are an alarming number of Americans overweight and obese now, over half the American population will be by 2015. They're actually predicting 75% of adults and 24% of children will be overweight or obese.
What can you do to avoid becoming one of them or to leave their ranks? Diet and exercise are simple to say, but not so simple to do. It helps to have support and that why I've started offering First Line Therapy in my office. First Line Therapy is a research based lifestyle program to improve all your risk factors for chronic diseases (including obesity, heart disease, diabetes and more).
Call the office and find out how you can join our First Line Therapy program. We are enrolling more people starting in August.
What can you do to avoid becoming one of them or to leave their ranks? Diet and exercise are simple to say, but not so simple to do. It helps to have support and that why I've started offering First Line Therapy in my office. First Line Therapy is a research based lifestyle program to improve all your risk factors for chronic diseases (including obesity, heart disease, diabetes and more).
Call the office and find out how you can join our First Line Therapy program. We are enrolling more people starting in August.
Catching up with vitamin D
19, 07 07, 23:29 Filed in: Medical
A recent (June 29, 2007) article points out that even in Hawaii, 11.1 hours/week of total body skin exposure (on average) is inadequate to get 51% of the participants to have an adequate amount of vitamin D (which they define as a level of 30 ng/ml, lower than I like). As the lead author states, "This implies that the common clinical recommendation to allow sun exposure to the hands and face for 15 minutes may not ensure vitamin D sufficiency."
This echoes nicely what I've been telling patients for some time based on my own experience of having pale skin, walking to work and taking supplements with 400 iu of vitamin D3 daily and still having a level of only 23: "15 minutes of sun exposure to hands and face daily adequate? A lie. 400 iu daily adequate? A lie."
The article ends with a conservative recommendation of "treating vitamin D deficiency with vitamin D supplementation, "it seems prudent" to aim for a serum 25-hydroxyvitamin D concentration no greater than the maximum produced by natural UV exposure; i.e., approximately 60 ng/mL."
They don't mention that it commonly takes 2,000-4,000 iu daily of D3 to get anywhere near that level, a dose that will give doctors with no nutritional background fecal incontinence. This dose will not get anyone near the lowest toxicity level seen of 150.
So, this article adds to the stack of journal articles supporting higher levels of vitamin D, but will it catch on among conventional docs? Not unless there are vitamin D reps coming in with donuts and pens that say "Vitamin D3" on them. If we're lucky, however, I'm wrong and every doc will start checking vitamin D levels, then recommending adequate vitamin D supplementation (for pennies a day) and cut the rates of cancer and degenerative diseases by huge amounts (some estimates say 50% reduction in cancer with adequate vitamin D).
If you want to learn more about the benefits of vitamin D, the Vitamin D council (.com or .org) is a good resource.
This echoes nicely what I've been telling patients for some time based on my own experience of having pale skin, walking to work and taking supplements with 400 iu of vitamin D3 daily and still having a level of only 23: "15 minutes of sun exposure to hands and face daily adequate? A lie. 400 iu daily adequate? A lie."
The article ends with a conservative recommendation of "treating vitamin D deficiency with vitamin D supplementation, "it seems prudent" to aim for a serum 25-hydroxyvitamin D concentration no greater than the maximum produced by natural UV exposure; i.e., approximately 60 ng/mL."
They don't mention that it commonly takes 2,000-4,000 iu daily of D3 to get anywhere near that level, a dose that will give doctors with no nutritional background fecal incontinence. This dose will not get anyone near the lowest toxicity level seen of 150.
So, this article adds to the stack of journal articles supporting higher levels of vitamin D, but will it catch on among conventional docs? Not unless there are vitamin D reps coming in with donuts and pens that say "Vitamin D3" on them. If we're lucky, however, I'm wrong and every doc will start checking vitamin D levels, then recommending adequate vitamin D supplementation (for pennies a day) and cut the rates of cancer and degenerative diseases by huge amounts (some estimates say 50% reduction in cancer with adequate vitamin D).
If you want to learn more about the benefits of vitamin D, the Vitamin D council (.com or .org) is a good resource.
Challenge to mammography screening before 50.
19, 06 07, 17:27 Filed in: Medical
The American College of Physicians noticed that all those mammograms in younger women may not be a good idea. This article doesn't mention the downsides like compression possibly rupturing tumor capsules or high radiation exposure from mammograms (which increase the risk of breast cancer, particularly in women at high risk). They did also admit that mammograms cannot prevent most breast cancer deaths. So, the final recommendation is that women 40-49 should discuss it with their doctors. If only more doctors knew about alternatives like thermography.
Thermography web site up!
03, 06 07, 17:23 Filed in: Office
After a month of tinkering and slaving away, I finally have a workable website for Ann Arbor Thermography. Please stop by http://aathermography.com and check it out. There's a contact page there where you can tell me what you think. I also have 2 other domain names that point to the same place: http://a2thermography.com and http://annarborthermography.com. Use whichever is easiest for you.
BCBS limiting prescriptions?
03, 06 07, 16:16 Filed in: Medical
I got the Blue Cross "Physician Update" the other day and noticed something alarming. In their quest to reduce expenditures, they are trying to limit what they are spending on prescriptions. Some of the things they are doing are reasonable (using generics where reasonable), but one is disturbing: "Enforcement to Exclude Off-Label Coverage", which "Helps curb prescription drug misuse."
"Off-label use" means using a drug for something other than what the FDA approved it. Keflex (cephalexin) is an antibiotic that has an approved use (the manufacturer did studies to show a benefit for) bacterial infections. There is a common off-label use for preventing bacterial cardiac infections in people who could get them from dental procedures (it is used for this in people who are allergic to penicillin, the usual medication for this).
In addition to the incredibly common off-label prescribing all physicians do, alternative doctors are prone to use things for off-label uses that aren't so common: Omacor (fish oil) for reducing joint pain, Clomid (clomiphene) for increasing low testosterone in men, low-dose naltrexone (LDN) as an immune stimulant in all kinds of diseases (MS, pancreatic cancer, rheumatoid arthritis...), etc. Indeed, it is the innovative use of current medications that drives progress and benefits patients without increasing costs.
Now BCBS seems to be saying that they will know better then the doctor what is appropriate for the patient. Maybe they are the ones practicing medicine without a license?
If you combine this with their threatening to take me off their PPO for "over-utilizing" (spending more than the average 6-15 min appt with patients and getting thorough testing on people), they're not my favorite insurance company right now.
"Off-label use" means using a drug for something other than what the FDA approved it. Keflex (cephalexin) is an antibiotic that has an approved use (the manufacturer did studies to show a benefit for) bacterial infections. There is a common off-label use for preventing bacterial cardiac infections in people who could get them from dental procedures (it is used for this in people who are allergic to penicillin, the usual medication for this).
In addition to the incredibly common off-label prescribing all physicians do, alternative doctors are prone to use things for off-label uses that aren't so common: Omacor (fish oil) for reducing joint pain, Clomid (clomiphene) for increasing low testosterone in men, low-dose naltrexone (LDN) as an immune stimulant in all kinds of diseases (MS, pancreatic cancer, rheumatoid arthritis...), etc. Indeed, it is the innovative use of current medications that drives progress and benefits patients without increasing costs.
Now BCBS seems to be saying that they will know better then the doctor what is appropriate for the patient. Maybe they are the ones practicing medicine without a license?
If you combine this with their threatening to take me off their PPO for "over-utilizing" (spending more than the average 6-15 min appt with patients and getting thorough testing on people), they're not my favorite insurance company right now.
Thermography is here!
29, 04 07, 20:58 Filed in: Office
Last weekend we went out to pick up and get trained on our new thermography equipment. I was floored by how sensitive it can be. I now have all the equipment up and running, so you can call and set up your appointments. We'll start only doing thermography on Fridays until we need to add more days. The number to call for thermography is 734-332-6290, which is still answered by the same people and you'll still come to the same office.
If you're wondering what screening thermography can do, it is a great way to do non-invasive breast cancer screening (more info here) (preferably in addition to mammography, but also for people who don't tolerate mammography or for whom mammography otherwise isn't a good idea), find the source of pain and look for other irregularities. You can learn more here (yes, it's in New Zealand, but it's a great compendium of quality information) until I get my own information pages set up.
If you're wondering what screening thermography can do, it is a great way to do non-invasive breast cancer screening (more info here) (preferably in addition to mammography, but also for people who don't tolerate mammography or for whom mammography otherwise isn't a good idea), find the source of pain and look for other irregularities. You can learn more here (yes, it's in New Zealand, but it's a great compendium of quality information) until I get my own information pages set up.
Wait times for new appointments
09, 04 07, 17:31 Filed in: Office
"The only ones who can claim to be above suspicion are those who are so much sought after that their cured patients are immediately replaced by fresh ones." -George Bernard Shaw, in the preface to The Doctor's Dilemma
Mr. Shaw was no fan of physicians. Would he have come to see me? Tough to say, but if the wait for a new patient appointment is anything to go by I should have satisfied his concern. The wait for new patients can be a few months, but give me a call regardless.
Drug Reps
25, 03 07, 20:22 Filed in: Medical
I've always been uncomfortable with drug reps: they're only there to get doctors to sell their stuff. I caught drug reps misrepresenting stuff in residency: not stuff they could have done by accident. As you may expect, I'm not a big fan of them.
I stumbled across a recent book, Confessions of an Rx Drug Pusher today and thought I'd share, especially since the posted chapter is pretty damning. Read that chapter here (I linked to the beginning of the chapter, skip all the stuff previous to it). The author is a 15-year veteran of drug sales. The story pretty much speaks for itself.
I stumbled across a recent book, Confessions of an Rx Drug Pusher today and thought I'd share, especially since the posted chapter is pretty damning. Read that chapter here (I linked to the beginning of the chapter, skip all the stuff previous to it). The author is a 15-year veteran of drug sales. The story pretty much speaks for itself.
Hormones and cardiovascular risk
17, 03 07, 09:42 Filed in: Medical
Sometimes I'm disappointed by the journals. Circulation recently had an article on reducing women's risk of cardiovascular risk, in which hormone replacement was listed as class III (not useful/effective, may cause harm). A summary of the article in Medscape breaks down the variation in risk:
So, there is risk in the standard hormone treatment of oral estrogen and progestins (synthetic progesterone-like molecules): each raises the risk of a clot 4-fold. However, it also shows that transdermal estrogen doesn't increase the risk and may lower it and that progesterone similarly doesn't raise the risk. Using bioidentical hormones in a smart manner, then doesn't raise the risk and likely lowers it going from this article.
Sadly, they also list folic acid and antioxidants in the same class that says "may cause harm". Clearly, no one has died from antioxidants or folic acid. There has been a limited number of studies showing some increase in risk with fractionated antioxidants (beta-carotene or alpha-tocopherol alone) in certain circumstances, so it is important to get use full-spectrum antioxidants when using higher doses (mixed carotenoids with selenium or mixed tocopherols).
Sadly, newspapers often pick up these articles without any background and trumpet it as fact. It pays to read in more depth, and be cautious about people who paint all hormone replacement with the same brush: there are clear differences in risk between approaches, and this is why I do not use oral estrogen at all.
Researchers found that "route, type, and dose" of hormone therapy matters, in the Estrogen and Thromboembolism and Risk Study (ESTHER), a multicenter study conducted in 8 hospitals in France that included 271 cases and 610 controls. Compared with nonusers, oral estrogen users had an odds ratio of 4.2 (95% confidence interval [CI], 1.5 - 11.6) and 0.09 [this is probably a typo and the risk should be 0.9] (95% CI, 0.4 - 2.3) for transdermal estrogen. Norpregnane derivatives were linked to a 4-fold increase in venous thromboembolism; but there was no risk for venous thromboembolism with micronized progesterone and pregnane derivatives in the study.
So, there is risk in the standard hormone treatment of oral estrogen and progestins (synthetic progesterone-like molecules): each raises the risk of a clot 4-fold. However, it also shows that transdermal estrogen doesn't increase the risk and may lower it and that progesterone similarly doesn't raise the risk. Using bioidentical hormones in a smart manner, then doesn't raise the risk and likely lowers it going from this article.
Sadly, they also list folic acid and antioxidants in the same class that says "may cause harm". Clearly, no one has died from antioxidants or folic acid. There has been a limited number of studies showing some increase in risk with fractionated antioxidants (beta-carotene or alpha-tocopherol alone) in certain circumstances, so it is important to get use full-spectrum antioxidants when using higher doses (mixed carotenoids with selenium or mixed tocopherols).
Sadly, newspapers often pick up these articles without any background and trumpet it as fact. It pays to read in more depth, and be cautious about people who paint all hormone replacement with the same brush: there are clear differences in risk between approaches, and this is why I do not use oral estrogen at all.
Wrong about echinacea
21, 01 07, 14:33 Filed in: Medical
It looks like I was wrong about echinacea. I had been saying that it is an effective anti-viral and immune-stimulatory herb hat should only be used for 2 weeks at a time. Now, after reading some more definitive research, I see that it is not only OK to take echinacea on a continual basis, but it actually is beneficial to take it this way. Therefore, my old adage that any company that puts echinacea into a daily vitamin doesn't know what they're doing and should be regarded with suspicion is wrong. This is a perfectly reasonable thing to include in a multivitamin, and (as demonstrated in the article on echinacea) may well extend life-spans. The research on mice showed a increase in survival in mice at any age, increasing with the age of the mice.
However, this doesn't mean that any old kind of echinacea will do the trick: other research shows that it is the alkylamides that are responsible for the anti-inflammatory effects and the polysaccharides and glycoproteins are responsible for the immune-stimulating effects, while the echinacosides and other things that OTC echinacea products are typically standardized for don't seem to have much activity, though the phenolic compounds do seem to help keep the alkylamides from degrading. Also, the dried plant materials lose potency quickly, so good echinacea doesn't come in a powder (unless you take massive amounts).
Also, I finally found the answer for which part of the echinacea (E. Augustifolia seems like the best, and E. Purpurea may be close, but E. Palladia isn't very good) to use when:
Roots harvested in the fall have the anti-inflammatory effects that are good for colds (typically the body will have already eliminated the virus before you start showing symptoms, so the inflammation is just part of the mopping-up process and there is no role for antibiotics at this point especially since colds are caused by a virus which wouldn't be affected by antibiotics even if they were still present despite your doctor having given you antibiotics in the past for a cold - this is an example of bad medicine from listening to too many drug reps and not reading any research or even just about any current literature on treatment of the common cold, but forgive my digression).
When the flowers are in early maturity, the aerial parts contain the immune-strengthening compounds that are good for keeping infections from starting in the first place.
So, I apologize to all the companies I had maligned for putting echinacea in their multivitamins (though they'd better check to see they're putting the right things in there) and especially to everyone who had heard my talks and also had it stuck in their heads the wrong way. It is for them that I am putting this in plain text so we call all get it straight once and for all.
However, this doesn't mean that any old kind of echinacea will do the trick: other research shows that it is the alkylamides that are responsible for the anti-inflammatory effects and the polysaccharides and glycoproteins are responsible for the immune-stimulating effects, while the echinacosides and other things that OTC echinacea products are typically standardized for don't seem to have much activity, though the phenolic compounds do seem to help keep the alkylamides from degrading. Also, the dried plant materials lose potency quickly, so good echinacea doesn't come in a powder (unless you take massive amounts).
Also, I finally found the answer for which part of the echinacea (E. Augustifolia seems like the best, and E. Purpurea may be close, but E. Palladia isn't very good) to use when:
Roots harvested in the fall have the anti-inflammatory effects that are good for colds (typically the body will have already eliminated the virus before you start showing symptoms, so the inflammation is just part of the mopping-up process and there is no role for antibiotics at this point especially since colds are caused by a virus which wouldn't be affected by antibiotics even if they were still present despite your doctor having given you antibiotics in the past for a cold - this is an example of bad medicine from listening to too many drug reps and not reading any research or even just about any current literature on treatment of the common cold, but forgive my digression).
When the flowers are in early maturity, the aerial parts contain the immune-strengthening compounds that are good for keeping infections from starting in the first place.
So, I apologize to all the companies I had maligned for putting echinacea in their multivitamins (though they'd better check to see they're putting the right things in there) and especially to everyone who had heard my talks and also had it stuck in their heads the wrong way. It is for them that I am putting this in plain text so we call all get it straight once and for all.
The future of the back
13, 01 07, 21:37 Filed in: Office
What will the construction bring?
Four new rooms in the back, a lab, a lounge for patients getting IVs, more windows and ventilation, eco- and allergy-friendly flooring, breathing room for everyone.
We'll see what we can do with the four rooms once we see how much it all costs. At a minimum, the IV Prep will return to the back in a real room with a sink and counter, storage will go to the back, and eventually my office will move back one room and the front desk will move into the front room, leaving more room for a family to sit in the front. The hyperbaric chamber may end up with its own room, too.
Some of the color choices are tricky when the place isn't built yet, but I hope they'll work out.
Four new rooms in the back, a lab, a lounge for patients getting IVs, more windows and ventilation, eco- and allergy-friendly flooring, breathing room for everyone.
We'll see what we can do with the four rooms once we see how much it all costs. At a minimum, the IV Prep will return to the back in a real room with a sink and counter, storage will go to the back, and eventually my office will move back one room and the front desk will move into the front room, leaving more room for a family to sit in the front. The hyperbaric chamber may end up with its own room, too.
Some of the color choices are tricky when the place isn't built yet, but I hope they'll work out.
Construction begins, Dr. Alspector moves
09, 01 07, 22:44 Filed in: Office
Construction on the back of my office has begun. We spent last week cleaning out the back of the office and moving it into the second room, so the back will become respectable space for our office.
In order to pack up this room, Dr. Alspector (who used to occupy it) has moved across the parking lot (to 190 Little Lake drive #5), and has graciously let us house our hyperbaric chamber over there until we have space for it once again. It is still usable, so call for an appointment.
During visits at our office, you may hear sounds of the construction in the back, but don't worry, they're not about to drill through the wall during your visit (though it may sound like it).
In order to pack up this room, Dr. Alspector (who used to occupy it) has moved across the parking lot (to 190 Little Lake drive #5), and has graciously let us house our hyperbaric chamber over there until we have space for it once again. It is still usable, so call for an appointment.
During visits at our office, you may hear sounds of the construction in the back, but don't worry, they're not about to drill through the wall during your visit (though it may sound like it).
