Monday, October 19, 2015

You and Your Microbiome, Are You Talking?

While we may feel stressed in the world, most of us would like to think of our own bodies as a calm place where we are in charge. But that may not be the case.

In the past ten years, we've discovered a vast unexplored region in the body, hidden in the gut. Research is showing that your gut bugs are not just for breakdown. They can affect everything from how your belly feels to how your brain functions.

So how well are you communicating? If you clear a room or have to leave your home spraying deodorant behind you with every number 2, then maybe your gut is trying to tell you something you don't want to hear.

There's so much about this subject, I wrote a short book for my patients. Have a look at your inner rainforest (and it is a rainforest). 


Monday, June 3, 2013

A World Without Cancer By Margaret Cuomo, M.D.


A World Without Cancer by Margaret Cuomo (yes, Mario Cuomo’s daughter)

I’m a sucker for M.D.’s coming up with a complete cure for cancer.  I just love the idea of addressing the global issues of cancer and coming clean about the fact we need to have a different paradigm.

Dr. Cuomo spends the first half of her book talking about the ills of the current cancer system, and the second half listing basic things that we can do to reverse the tide.  Midway along, we get a call for a new institute based on the idea of preventing cancer.  So that’s how we’ll get a World Without Cancer: start a new institute.

In looking at the information, the discussion of the ills of the current system was far more informative than the cursory overview of what we can do about it. 

Dr. Cuomo makes general claims about cancer care, but most of them apply to breast cancer.  In discussing breast cancer, mammograms reduce breast cancer deaths from 3.5 to 3 per 1000 patients (p.47).  We have an interesting take on the need to get informed consent from patients:  “some will become informed consumers…Many will not, and that’s reasonable too” (p.55).  In a disturbing insight about what constitutes a clear margin in cancer surgery:  “no strict agreement on how large it should be, leaving surgeons to make decisions” (p.61)  We get another support of the lumpectomy over complete mastectomy, and the fact that the choice is not given to many women (p.62).

On p. 72 we learn that Gleevec cures CML, the rare exception to chemotherapy drugs.  (In a follow up, Gleevec is no longer first line therapy as of 2011 as CML is too often resistant (http://jnci.oxfordjournals.org/content/103/4/E1.long)

When we move into the money matters, things get really ugly.

The pharmaceutical industry is the most profitable industry in America, holding monopolies on its products for twenty years (p.86).  Oncology drugs provide the highest source of growth for the industry (p.84).  Medicare and Medicaid are barred from negotiating prices for drugs, unlike the Veteran’s Affairs Department which pays 48% less on the most frequently prescribed drugs (p.87).  In 1991 Medicare paid 7,100 on average for lung cancer chemotherapy.  In 2002, the same treatment cost $40,000, an increase of 500% without any increase in survival rates (p.88). 

Despite discussions of market economics, the disconnect between insurance payer and covered patient shows that consumption of the drugs is not significantly altered by costs (p.92).  New drugs on the market may be called “new standards” (1.2 months more life at $80,000 cost) or “game changer” (2 months more at $120,000 cost).  In comparison, placing patients in end-of-life hospice care provides an average of 3 months more life (p.99).  We pretend we can afford to pay for everything (p.109) and institutes looking at patient outcomes are barred from considering cost as part of their evaluations (p.110). 

Despite being insured, we are currently seeing rationing with cancer drugs.  “Prescribing different medicines to different patients based on their health care plans.” (p.111).  Of households affected with cancer, 25% used up all savings, and 11% were unable to meet basic necessities despite having insurance (p.120).  Adults with Medicare can pay as much as $6,000 out of pocket for cancer therapies of marginal benefit (p.121). 

Doctors get paid to prescribe and administer treatment (p.159).  One third of oncologists felt uncomfortable discussing the costs of chemotherapy with their patients (p.123).  Dr. Cuomo ends her discussion of the current state of cancer care by asking us to change our whole gestalt (complete picture) and not to demonize any one player (drug companies, doctors, FDA) while we look for other solutions.

Dr. Cuomo’s solutions are not a prescription for a world without cancer.  They are a step in the right direction.   As a radiologist, she takes issue with the ordering of so many CT scans, each one equaling 100 to 800 chest X-rays (p.172).  The CT machines themselves have a 13 fold variation between highest and lowest exposure to radiation depending on how the machine is calibrated.  So most people are getting more radiation than they need to during a CT scan (p.173). 

The diet piece of cancer prevention reads like every cancer prevention diet:  fruits and vegetables, berries, cruciferous vegetables (broccoli), tomatoes, dark leafy greens.  We should buy organic, eat more fiber and fish, drink green tea, limit alcohol, and avoid processed foods.  Add turmeric to your diet and avoid red meat.  Limit alcohol and avoid processed foods. 

Dr. Cuomo is not a fan of supplements except to gush over vitamin D, recommending fairly high doses of that and calcium. 

When I picked up the book, I was looking for a paradigm change.  What I got was a reality check that a trillion dollar cancer-war industry needs to change (ie. lose an enormous amount of money).  That industry has, since the war on cancer started, gone in one direction (more drugs, more expensive drugs) and has every incentive to keep doing more of the same.   In the meantime, I’m supposed to eat well.    

Wednesday, May 8, 2013

Gold, Frankincense, and Myrrh: Which of These Was Most Useful?

We've all heard the story. Matthew 2:11 talks about Gold, Frankincense and Myrrh. So which of these was the most useful? From a strictly monetary point of view, it was the gold. That would allow mom to buy some things for the baby. But what of the other two? Myrrh is a powerful natural antibiotic. It is part of a formula I use successfully to treat sinusitis. In his early years, the baby would have benefitted from having this around for the illnesses of youth. Frankincense is a powerful pain reliever for arthritis. Now we have multiple randomized studies showing that it benefits arthritis sufferers. So all three were equally valuable for the child. 

Wednesday, December 5, 2012

I just finished listening to the short book Many Lives, Many Masters by Brian Weiss. It's always hard when someone goes from being a nonbeliever to being someone who says: "this is exactly what the afterlife looks like, and here is the meaning of life for everyone." Clearly the rendition of what was said by his patient in hypnotic state was in line with what would translate for him. The Masters said as much, and even his patient didn't want to listen to the recordings. But it was interesting to hear about his search of the literature and the extensive research that has been done on these issues. I simply don't see any of this literature making its way into the hospital wards and nursing homes, which is unfortunately where most of us go to die. I've also talked to several hospital pastors who are more and more non-denominational these days. Hospice seems to do the best in terms of dealing with spiritual issues, but if someone is dying of an acute illness (and therefore needs the most help quickly) we don't have the resources in place to address their spiritual needs. I know it will never be a hospital priority, but it doesn't even seem to be on the radar in most locations. Muchas vidas, muchos maestros / Many Lives, Many Masters By Weiss, Brian (Google Affiliate Ad)

Wednesday, September 12, 2012

Strange Things For The Sake of Science: Ben Franklin Fries a Turkey

Most of us know that Ben Franklin did things with electricity.  But few of us realize we almost lost him on Dec. 23, 1750.  Ben and his buddies were fixing to fry themselves a turkey, using a built up charge of this magical new electricity.  Franklin got distracted and sent the charge through himself instead.  Fortunately for him and for all of us, his charge was only enough to daze him for a few minutes.  Later on he got together a bigger charge and fried a turkey with it. 

Read this anecdote and many more in the aptly named Electrified Sheep by Alex Boese.  Bed time stories for the geek in all of us. 

Monday, April 16, 2012

Good Calories, Bad Calories: Ignoring the Paradox And Trashing Carbs.

In reading Good Calories, Bad Calories, there is a hope that the author will give a balanced viewpoint of the situation.  He disproves the idea that fat causes weight gain, then takes issue with the idea that carbs cause weight gain. 



In a chapter entitle the Paradox, he points out that when you starve people they lose various amounts of weight.  He also shows that when you stuff people they gain various amounts of weight.  So any blanket statement about weight gain and weight loss is moot.  It doesn't exist. 

Then, because everyone needs an ending, he goes back to carbs and makes them the villain.  It isn't just the carbs, it's the insulin imbalance caused by the carbs.  But wait, didn't we just show that it wasn't straight carbs and that any weight gain or loss is a highly individualized process?   Under those circumstances, wouldn't it be possible that some individuals might even gain weight by eating fat? 

What starts off extremely well becomes one more carb trash fest while glorying the joys of meat and fat.  What's missing from all this is some allowance for the fact that we all cannot eat meat and survive as a planet.  It isn't a sustainable eating pattern, and it isn't terribly healthy.  We've got other books that make that clear.  They are focused on lifespan, rather than weight loss. 

Sunday, April 15, 2012

The End Of Illness. David Agus' Inability to See His Own Prejudices.

One day I too hope to write the definitive book on the cure for Cancer.  But I think I will base my treatment protocols on more than one reference book.   

Let me begin by saying I like much of The End of Illness.  Dr. Agus and I agree on many things, including that Michael Pollan does a wonderful job of talking about food.  But my admiration for Pollan does not distract me from the simple reality that Pollan is one of hundreds of opinions about food and what we should eat. 



So, I do not base my recommendations about food while referencing a single author, no matter how authoritative. 

Given that Dr. Agus' focus is on food, and that he spends a great deal of time trashing supplements of all kinds, I would expect a little more emphasis on what will be the most curative diet.  For it is diet alone, and nothing else, that will impact our genetic inheritance and help us live. 

I disagree with the concept that we'll be getting personalized medication any time soon.  Perhaps the very wealthy will be able to afford the sort of technological testing Dr. Agus describes, but the reality is that for almost everyone modern medicine is too expensive already. 

And here is the the fundamental flaw I see in the End of Illness.  Dr. Agus dedicates a huge section of the book to really making readers second-guess taking even a multivitamin because of the possible health consequences.  But he waxes rhapsodic about the benefits of the Statin medications and baby aspirin, taking both himself for "preventative purposes."  Hello?  We're not talking about inert medications.  A statistic percent of those following Dr. Agus' recommendations of daily statins and baby aspirins will suffer debilitating muscle pains and/or hemorrhagic stroke as a result of his "preventative" pharmaceutical supplements.  While we have large studies that show possible risks from overuse of multivitamins, we have no large scale studies that confirm the benefits of statins or aspirin for the general population without the real risk of side effects for a minority of those individuals. 

To place preventative supplementation off limits as a clear negative while recommending pharmaceutical medications as healthy and safe clearly shows a prejudice and double-standard for conventional medical "solutions."  Given the cost and safety profile of the statins, they are at least as dangerous for the general population as the Vitamin E supplements that Dr. Agus so effectively vilifies.  And aspirin is as dangerous to elderly populations as their multivitamin.  So we are left with food as the only panacea, and that needs a bit more book time that simply gushing over Pollan's ideas.