Wednesday, December 14, 2011

My Two Cents: Two Pennies For Lithgow Library

It often seems in this crazy world we cannot make a dent in things.  But all you can do is throw in your two cents.  I just did in the local library debate by writing a book based on the history of our library (don't worry, it's full of Masonic intrigue-really).  Buy the book to support the library, because they get any profits.  Just my two cents.  I gave my granpa authorship credit for reaching his 100th birthday.

Go to the booksite here.

Monday, November 21, 2011

Is Organic Better? Yes, Mostly.

I've addressed the various issues with judging whether organic foods are better than conventional produce on my website.  http://www.maloneymedical.com/id156.html

The short answer continues to be that organic produce does, in fact, have more of some nutrients than its conventional cousin.  It varies from season to season and crop to crop.  Let's acknowledge that, and move on.  Unfortunately, places like the Mayo Clinic like to sound like authorities, and so cite one review (covering the last fifty years?  Don't get me started on soil depletion, changing farming methods, etc.) and say probably there's no difference.  I'd say some researcher needs to take the Twinkie out of his mouth and realize he's just set the debate back to the dark ages of the 1960's. 

Our current discussion needs to focus on the process of becoming locavores.  This term needs to enter the mainstream in the same way that vegetarian is now part of common knowledge.  If you are unfamiliar with this concept, here's a starting point.  Many people here in Maine have been locavores for decades, but have subsidized an otherwise exemplary diet full of fresh and flash frozen vegetables from their giant gardens with deep fried food.  All they need to do to get healthier is stop eating out.

For the crunchies among us, put down that Ecuadorian arugula.  It isn't in season, and you've just consumed a full tank of gasoline along with your "spring veggies."  Oh, I'm guilty as well, and everything in moderation.  But let's all keep humble and have a look at what our neighbors are doing right.  If we focus, necessity and intention meld together to make it more and more obvious that our only possible way out of our issues is to work together on every issue.     

Monday, November 14, 2011

EU Stops the Regular Use of Antibiotics For Animals, Time for Homeopathy To Shine?

I first read about the transition from the homeopaths at NCH, but  I doublechecked and confirmed at the Union of Concerned Scientists, which gives a different, supportive take on the banning of antibiotics in animal feed.

From a homeopaths' viewpoint, the banning of antibiotics is an opportunity to test whether homeopathy can be helpful.  In the never-ending, howling skepticism of homeopathy its critics have failed to notice reports of better outcomes for animals placed on homeopathics.  The data is good enough to inspire the EU to invest "1.8m in a pilot research project to examine the effectiveness of homeopathic treatments on farm animals." 

The arguments against homeopathy pale when we are faced with a very real possibility that within our lifetimes we will not have antibiotics as an effective tool.  It is far preferable to deal with the realities of commercial farming without an antibiotic buffer now than to wait until complete resistance is the norm. 

Here's a recent study:

Homeopathy. 2010 Jan;99(1):57-62.

Homeopathy as replacement to antibiotics in the case of Escherichia coli diarrhoea in neonatal piglets.

Source

Biological Farming Systems Group, Wageningen University, Droevendaalsesteeg 1, 6708 PB Wageningen, The Netherlands. Irene.Camarlink@wor.nl

Abstract

BACKGROUND:

The use of antibiotics in the livestock sector is increasing to such an extent that it threatens negative consequences for human health, animal health and the environment. Homeopathy might be an alternative to antibiotics. It has therefore been tested in a randomised placebo-controlled trial to prevent Escherichia coli diarrhoea in neonatal piglets.

METHOD:

On a commercial pig farm 52 sows of different parities, in their last month of gestation, were treated twice a week with either the homeopathic agent Coli 30K or placebo. The 525 piglets born from these sows were scored for occurrence and duration of diarrhoea.

RESULTS:

Piglets of the homeopathic treated group had significantly less E. coli diarrhoea than piglets in the placebo group (P<.0001). Especially piglets from first parity sows gave a good response to treatment with Coli 30K. The diarrhoea seemed to be less severe in the homeopathically treated litters, there was less transmission and duration appeared shorter.
Copyright 2009. Published by Elsevier Ltd.
PMID:  20129177

Saturday, November 5, 2011

Kubler-Ross and the Autumn

The Stages of Fall:  Transition Into Winter

I've noticed the stages of dealing with the autumn mimic the stages of Transition here in Maine.

First, we work through our denial.  It isn't just the people, the plants are just as busy trying to outgrow each other.  Winter won't come our way if we don't look at it. 

With the first early winter snow this year before Halloween, we have moved into the anger stage.  Racks of shovels adorn every store.  The armamentary of snowblowers and snow melters and heaters line our sidewalks.  We will battle snow with every ounce of our will.

But already we've moved into the bargaining stage.  We're trying to limit the damage.  I've already said, "no more than twelve feet this year."  As if somehow I could bargain with the winter winds.  Will six inches really make a difference to my year?

And I've seen in my patients the depression beginning.  They talk about the cold winter months and getting out of Maine for the season.  Many will, but those that do will be gone by November.  The rest of us will hunker down for the season.  Days will shorten to mere slivers, and the long, windy nights will swallow up the sun. 

Even as I write, I feel the creeping of acceptance.  It is a relief to let go of having to be everywhere on time.  Whole days can just come crunching to a halt.  Plans will be remade, or cast aside.  And the sun will come again. 

Here's a link to Kubler-Ross' stages of grief

Saturday, October 29, 2011

Live First, Work Second: Understand the Young

New book out with a lovely title: Live First, Work Second.  Thanks to Candyce Carden-Deal of Candidness for bringing it to my attention.  She has a great blog post that describes the book.

Thursday, October 20, 2011

Is Andy Kaufman dead?

There is a documentary out about Andy Kaufman asking whether he really is dead.  I was intrigued because the director shares my name.  But really, if Andy was alive, he'd be doing something else besides laying low.  On the other hand, the weathermen taught us that you can hide in plain sight.

Monday, October 17, 2011

Walking Dead: Shocking? Really? Isn't Everyone Supposed To Die?

I had the misfortune to develop an interest in the Walking Dead recently.  Blame it on the recent Austen/zombie book.  I wanted to see what a drama would be like played out against a zombie backdrop. 

In the first episode, we begin with the hero blowing away a young blonde girl turned zombie.  So children getting shot is how the series begins.  Imagine my surprise when in the opener of the second season they...have a child getting shot. 

Evidently my memory is longer than the reviewers, who are all atwitter (pun intended) with what it means to the morals of television now that a child has been shot.  Really?  Did you miss the horse getting eaten?  How about the walkers getting beaten to second death with bats?  Did you close your eyes during the moment when a man has to shoot his walker wife in the head? 

My biggest issue with Walking Dead is that I do not believe our hero survived the initial slaughter lying comatose in his hospital bed.  First, the walkers can smell people, so a bed across the door isn't going to deter them.  Second, there is no way he didn't die of thirst while his beard grew to the length it did.  World full of zombies who never die, fine.  But don't fake dehydration. 

I also found that I don't really care about the characters, so I stopped watching. 

Tuesday, September 27, 2011

Dead Sea Scrolls: At Last Something Worth Reading Online.

Well, the scrolls are out!  http://dss.collections.imj.org.il/ has all the scrolls, but I was severely disappointed that, unlike the Great Isaiah scroll, the war scroll isn't readable as an instant translation.  Come on, we'd be talking endless online comparisons to end-time current day war activity as everyone and their brother tries to fit different players into the narrative. 

But we do have some pretty exciting reading.  Here we have a PG 13 section:  Chapter 3 : Verse 17
"Therefore the L-rd will smite with a scab the crown of the head of the daughters of Zion, and HaShem will lay bare their secret parts."  A bit further on: Chapter 4 : Verse 1  "And seven women shall take hold of one man in that day, saying: 'We will eat our own bread, and wear our own apparel; only let us be called by thy name; take thou away our reproach.'"

We also have some poetry:  Chapter 5 : Verse 18
Woe unto them that draw iniquity with cords of vanity, and sin as it were with a cart rope,

So I'm looking forward to lots of sermons and interpretations from our biblical preachers worldwide.  Not just the scholar types, but the ones who preach everyday from the current texts.  How will the scrolls factor in?

Sunday, September 25, 2011

Confessions of a Jane Austen Addict

I just finished listening to the book and I was pleasantly surprised by the author's ability to pay homage to Austen without losing a reasonable, though implausible, storyline. 

Friday, September 9, 2011

How Do We Undo The Obesity Epidemic? The Australian Solution.

Fat, Sick & Nearly DeadIt's hard to make weight loss into a movie, and it's harder to make it inspiring without a hard sell approach.  I was impressed by Fat, Sick and Nearly Dead.  Unlike almost any weight loss program I've seen, it really is about people getting well without any money in it for the producer. 

The movie is available at Netflix streaming, but you could also get a copy (so you can hand it to your relatives where it will sit on the shelf gathering dust until they have heart attacks like Bear in the movie did). 

If anyone is looking for someone to monitor the fast and do blood work, this is one I can get behind.  It's not permanent, but it is sustainable over time, and it's based on fruits and vegetables.
You can just look at the diet, but I'd watch the movie.  It's not often you see a trucker become an actor and make the transition gracefully. 

Friday, July 1, 2011

17 Day Diet, Really the 68 Day Diet

Well, like anyone I was intrigued by the idea of a 17 day diet.  Really?  That's all it takes to conquer obesity in America?  How could we have been so foolish? 

But then I found out it was really four cycles of 17 days, and I thought:  this guy's been watching too many late night infomercials:  "Just four cycles of 17 days each..."  but the 68 day diet just doesn't sound as sexy.

You can do the 17 minute workout, get the 17 day meal packages, spend a great deal of time thinking about why it isn't the 15.7 day diet or the 18.33 day diet.  When you watch Dr. Moreno defend the 17 there really isn't any reason why the other two numbers wouldn't work.  Wouldn't part of a day be better at confusing the body? 

In the end, it's one more young, healthy male doctor explaining to middle aged women that they just need more discipline when really it's a matter of hormones.  

Monday, June 20, 2011

Guillain-Barre: An Unknown Taking Down the Healthy Or A Worsening Chronic Infection?

A recent story on ex-quarterback Danny Wuerffel getting Guillain-Barre Sydrome has been in the news recently.

In looking at his symptoms, he came down with a stomach virus, and now is at 50% muscle strength.  Not only is this terrifying, it leads to the thought that none of us is safe. 

For anyone living in a box, Guillain-Barre has historically been associated with vaccinations.  More recent re-analysis of previous studies poo-poo any possible association, but have a look at the 1978 original study:  "that the risk of Guillain-Barré syndrome among individuals receiving immunization against influenza A/New Jersey is 7.3 times the risk among the nonvaccinated."  (Adv Neurol. 1978;19:249-60.)


It is a miniscule risk, and shouldn't deter anyone from vaccination for that reason alone, but the association makes sense if one thinks about the fact that the virus is often simply weakened, not entirely dead.  In a very few susceptible individuals it may spark an autoimmune cascade. 


The truth is that we've got a pretty good idea of what is causing this cascade.  It may vary from individual to individual, but the majority have antibodies that correspond to both an infectious agent and their own neural tissue.  A recent study (J Neurol. 2011 Apr 24. ) found that a quarter of all patients had been infected by Campylobacter jejuni.  Another recent study in China concludes:  "Our results suggest that the antecedent C. jejuni infection triggered this GBS outbreak in China." (Foodborne Pathog Dis. 2010 Aug;7(8):913-9.)  So at least 25% of patients might benefit from antibiotic treatment.  Minocycline has been used to successfully treat an animal model of Guillain-Barre.  (J Cell Mol Med. 2009 Feb;13(2):341-51. )


Currently the standard of care for Guillain-Barre involves intense rehabilitation, IV antibodies, and exchanging plasma for patients.  All of these may be effective only if the body does not continue to generate antibodies from an ongoing infection.


For individuals without medical resources (and that is more and more people here in the U.S.) there are preliminary studies on the effect of ginger, licorice, calendula, and fenugreek.  (Phytother Res. 2010 May;24(5):649-56.)


It shouldn't take a celebrity case to bring the standard of care of this illness in line with the most recent research. 


 

Saturday, June 18, 2011

What I Eat: How to Blow Your Mind and Reframe How You Think About Diet.

I love this book!  It's a coffee table picture book, full of exotic meals and strange locales.  But it's arranged by daily calorie intake from 800 to 12000 calories a day.  If you ever wanted visual proof that caloric intake does not correlate to weight, here's your evidence.  We've got people starving themselves and staying fat, while thin people eat twice the calories (and no, they aren't all bike messengers). 

It was $40 at Barnes and Noble, but I paid full price because I wanted it to look over and because I couldn't remember the title before.  It's a fairly stunning rejection of the west's sacred cow of calorie counting. 

Wednesday, June 15, 2011

The Looking Glass Wars: Alice's "Real" Life.

I have two Boston friends for whom Alice was not only an inspiration, but I think a big part of their marriage.  So I plodded through the Looking Glass Wars, book 1, and skipped the second one to move onto book 3.  Evidently nothing happens in book 2, because I pretty much feel like I missed a chapter starting book 3. 

The initial book was fascinating because it worked on how to combine Alice's real life with her Wonderland life.  I learned a few things about her life that I didn't know, but I'm sure Aliceophiliacs would understand.  But by the end of the first book Wonderland Alice has created a double of herself in the real world, creating no need to continue her double life.  I would have found it much more interesting to have her forced to go back and forth. 

But I plan to finish the series out of honor to my friends and because I did indeed become interested in Alice as a person.  So for those of you looking for a remix and remaster of Alice in Wonderland, this is a great read.

Saturday, May 21, 2011

Multiply Can Use Blogger, But Not Cleanly

When I imported all my Blogger Natural Treatment Therapies information to Multiply, another social networking site, the end result is an unsatisfactory set of text blocks without any of the advantages of the original site.

So Natural Treatment Therapies will be staying exactly where it is. I suspect that in the end what I've just experienced is exactly the reason that we'll eventually see a decline in online networking. Problems with communicating what we really mean.

In the old days we talked about the game of telephone, where one person whispers in another person's ear. As you went around the room, the message got less and less coherent.

How often today I deal with issues generated by texting miscommunications. Where is the class for the average person in concise, appropriate texting? I know I need one. How do you deal with multiple messages when you're busy? Is 'k an appropiate response or are you being rude? If 90% of communication is non-verbal, where does that leave any of us online?

I wonder what we've become when online communication is how we find each other and how we judge each other.

Wednesday, May 18, 2011

Does Alternative Medicine Cost More Money Or Less For Fibromyalgia?

There are two schools of thought on this issue.  One says that adding insurance coverage for alternative medicine will cost more money because people will use both.  The other says that using alternative medicine saves money because people get less sick and take care of themselves more.  Can we have the drumroll please?  The cost less people win!  Washington state did an analysis of people who had coverage and the people who use alternative medicine cost the insurance companies about $400 dollars less.  Most interesting is that the really sick people cost insurers almost $1500 less per year.  Some of these people had  back pain, fibromyalgia or menopausal symptoms. 

In terms of Fibromyalgia, I went looking for the alternatives for Fibromyalgia on WebMD.  The person writing about Fibromyalgia is an M.D. who happens to have Fibromyalgia.  He's written thirteen books on Fibromyalgia.  He also happens to be "a physician speaker for pharmaceutical companies that make medications used to treat fibromyalgia."  I sense a vague conflict of interest when discussing alternative treatments as primary. Not surprisingly, he doesn't mention dietary change, GABA, DHEA, probiotics, or a range of other likely treatments.  Instead he focuses on a number of antidepressant herbs that are basically milder versions of the antidepressant pharmaceuticals being used.   

In focusing on the antidepressant aspect of treatment, our expert is playing to the "all in your head" phenomenon I see more and more often in chronic diseases.  But the reality is that a range of other factors affect Fibromyalgia patients, including a blunted adrenal response.  A number of different studies support this connection (one is below).  So rather than saying it's all in your head, we should be looking at the rest of the body.  Maybe this is why alternative medicine saves people money.  We look toward the big picture rather than just managing the symptoms. 

J Rehabil Med. 2010 Sep;42(8):765-72.


Evidence of reduced sympatho-adrenal and hypothalamic-pituitary activity during static muscular work in patients with fibromyalgia.

Kadetoff D, Kosek E.

SourceOsher Center For Integrative Medicine, Stockholm Brain Institute, Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden.
Abstract

OBJECTIVE: To assess activation of the sympathetic nervous system and the hypothalamic-pituitary-adrenocortical axis during static exercise in patients with fibromyalgia.
PATIENTS AND METHODS: Sixteen patients with fibromyalgia and 16 healthy controls performed a static knee extension until exhaustion. Plasma catecholamines, adrenocorticotropic hormone and cortisol, as well as blood pressure and heart rate, were assessed before, during and following contraction. Plasma C reactive protein was analysed at baseline.
RESULTS: Blood pressure and heart rate increased during contraction (p < 0.001) and decreased following contraction (p < 0.001) in both groups alike. Compared with baseline, plasma catecholamines increased during contraction in both groups (p < 0.001), but patients with fibromyalgia had lower levels of plasma adrenaline (p < 0.04) and noradrenaline (p < 0.08) at all times. Adrenocorticotropic hormone increased at exhaustion in controls (p < 0.001), but not in patients with fibromyalgia, who also had lower adrenocorticotropic hormone at exhaustion (p < 0.02) compared with controls. There were no group differences, or changes over time in plasma cortisol. High sensitivity C reactive protein was higher in patients with fibromyalgia compared with controls (p < 0.02).





Friday, May 6, 2011

Dude, Where's My Electric Car?

Warning:  The following is a thinly veiled rant by a gasoline addict feeling the pain of the pump. 

Ooh, big oil crunched it before they decided to maim our economic recovery at the pump.  You can read the spoiler for this movie at Wikipedia. 

In crazy news, the same guys who killed the electric car are bringing it back.  Funny thing, though, it has the same problems (short range/high price) that it did before even though we've evidently invested heavily in new technology.  Since these are the same people who got rid of the other electric cars years ago, as well as dismantling our public transportation systems decades ago, I'm vaguely suspicious.   

Don't we own most of the car companies now?  Shouldn't we be selling ourselves a decent car at a decent price?  Maybe even putting batteries at every gas station or grocery store (we do for propane tanks, so what's the problem?)

How is it that it's pretty darn impossible to make tiny functional electric cars for a decent price, but Tesla Motors is making roadsters for 100k?  I'm sorry, but it occurs to me that some enterprising soul with cheap labor and a liberal view on copyright infringement might buy one and take a look under the hood.  I certainly wouldn't want to condone such behavior, but it seems to happen with every other consumer good.  How is it possible that cars have tighter security than any other electronic device?

Oh, we can buy cheaper cars, but they have a forty mile radius and a 25 mph top speed.  Doesn't my kid's electric hotwheel getting faster than that?   

So, we'll have to build our own.  Here's the starter kit blog.  I'll get right to it as soon as I finish my fully enclosed greenhouse backyard.  Now, if only my neighbors didn't have so many trees...



Wednesday, May 4, 2011

How To Drag Your Children Away From Their IPods.

















Remember when children just got their brothers hand-me-down jeans?  Nowadays, we have hand-me-down electronics.  My elder son is the proud owner of IPod sixteen or something, which seems about ready to take off (didn't IPod take over the shuttle missions?  I think it's a free app.)  He worked like a dog and saved his money (my money, but I got chores out of it).  So his brother received his hand-me-down IPod.  I've been dealing with App anxiety all week. 

I had a vision of a different time, when my father read to us in the evening.  So I went to the library (yes, they still have those, although ours desperately needs renovation).  My mission was to engage my children with literature or at least dime store novels. 

I picked out The Book of Three, Dune, Harriet the Spy, the Elfstones of Shannara, and Dragonsong.  I figured something was bound to take. 

As you may have guessed, my elder one played IPod silently while listening.  But my four year old sat and played legos.  Both of them want me to continue tomorrow. 

The boys picked Elfstones after some debate.  Book of Three was second.  My twelve year old was reading Dune after his brother went to bed.  Sometimes, just sometimes, we can make a stand in the sands of time and create a little family space amidst the din. 

Thursday, April 28, 2011

Mercy Hospital's Definition of Naturopathy: MD Diagnosis, alternative treatment.

I was very pleasantly surprised by Mercy Hospital's lovely discussion of CAM.  I like their definition of Naturopathy, which is succinct if a little inaccurate.  Generally we spend an great deal more time diagnosing than what is allowed by a fifteen minute office visit.  We also tend to try and link different body symptoms together:  chronic tension and upset stomach, insomnia and foot pain, etc. 

I've compiled a definition of Naturopathy under What in the World is a Naturopath?  It gives the scope of Naturopathy in comparison to MDs and DOs. 

Tuesday, April 26, 2011

Thirteen Virtues: Does Anyone Do Ben's List Today?

When he was twenty years old, Benjamin Franklin wrote a list of virtues for himself and evidently tried to practice them for the rest of his life. 

So there's a free website set up called Thirteen Virtue.com, but it appears to be defunct.  So is anyone still trying to follow Franklin's advice? 

I admit to trying, but I never really got into it.  Maybe a week is too long a period for modern life. 

Here are the virtues (listed on Wikipedia.)

1.Temperance. Eat not to dullness; drink not to elevation.


2.Silence. Speak not but what may benefit others or yourself; avoid trifling conversation.

3.Order. Let all your things have their places; let each part of your business have its time.

4.Resolution. Resolve to perform what you ought; perform without fail what you resolve.

5.Frugality. Make no expense but to do good to others or yourself; i.e., waste nothing.

6.Industry. Lose no time; be always employ'd in something useful; cut off all unnecessary actions.

7.Sincerity. Use no hurtful deceit; think innocently and justly, and, if you speak, speak accordingly.

8.Justice. Wrong none by doing injuries, or omitting the benefits that are your duty.

9.Moderation. Avoid extremes; forbear resenting injuries so much as you think they deserve.

10.Cleanliness. Tolerate no uncleanliness in body, cloaths, or habitation.

11.Tranquillity. Be not disturbed at trifles, or at accidents common or unavoidable.

12.Chastity. Rarely use venery but for health or offspring, never to dullness, weakness, or the injury of your own or another's peace or reputation.

13.Humility. Imitate Jesus and Socrates.

Friday, April 22, 2011

Heartburn: Now It's a Problem for Kids?

It's very troubling to have the expansion of heartburn medication to children and even infants.  Especially when we have no evidence that they are effective and we do have evidence that long term use of acid blockers affects bone health.  But without evidence, we're still seeing prescriptions for the medication.  Here's the expert meta-analysis from the Cochrane database.  I've highlighted the relevant sentence. 

Pediatrics. 2011 Apr 4. [Epub ahead of print]


Efficacy of Proton-Pump Inhibitors in Children With Gastroesophageal Reflux Disease: A Systematic Review.

van der Pol RJ, Smits MJ, van Wijk MP, Omari TI, Tabbers MM, Benninga MA.

SourceDepartment of Pediatric Gastroenterology and Nutrition, Emma Children's Hospital AMC, Amsterdam, Netherlands;

Abstract

Introduction: Use of proton-pump inhibitors (PPIs) for the treatment of gastroesophageal reflux disease (GERD) in children has increased enormously. However, effectiveness and safety of PPIs for pediatric GERD are under debate. Objectives: We performed a systematic review to determine effectiveness and safety of PPIs in children with GERD. Methods: We searched PubMed, Embase, and the Cochrane Database of Systematic Reviews for randomized controlled trials and crossover studies investigating efficacy and safety of PPIs in children aged 0 to 18 years with GERD for reduction in GERD symptoms, gastric pH, histologic aberrations, and reported adverse events. Results: Twelve studies were included with data from children aged 0-17 years. For infants, PPIs were more effective in 1 study (compared with hydrolyzed formula), not effective in 2 studies, and equally effective in 2 studies (compared with placebo) for the reduction of GERD symptoms. For children and adolescents, PPIs were equally effective (compared with alginates, ranitidine, or a different PPI dosage). For gastric acidity, in infants and children PPIs were more effective (compared with placebo, alginates, or ranitidine) in 4 studies. For reducing histologic aberrations, PPIs showed no difference (compared with ranitidine or alginates) in 3 studies. Six studies reported no differences in treatment-related adverse events (compared with placebo or a different PPI dosage). Conclusions: PPIs are not effective in reducing GERD symptoms in infants. Placebo-controlled trials in older children are lacking. Although PPIs seem to be well tolerated during short-term use, evidence supporting the safety of PPIs is lacking.

PMID:21464183

So let's all step away from treating colic, which is likely to be associated with overgrowth of bacteria, with acid blockers. 

I have extensive information on options for adults on my website:  http://www.maloneymedical.com/ under What Do I Treat? and GERD

Tuesday, April 19, 2011

How Many of Us Are Dying Because We Go To Our Doctors? (As Opposed To Dying Because We Can't Afford To Go.)

I'm often curious about the denial of the pretty clear reality that our medical system needs serious help.  One of the denial sticking points is the number of deaths directly attributable to medical care.  Let's be clear.  Almost everyone dies under medical care at some point.  But a fair percent of patients are helped on their way unnecessarily and prematurely by the very people who want to preserve their lives. 

We rank poorly (twelfth out of fifteen) in comparison to other industrialized nations' healthcare.  Before you blame the fat Americans, we rank 3rd lowest in smokers and fifth lowest in drinkers.  U.S. men 50-70 have the lowest cholesterol of the group.  So it isn't just that we're less healthy. 

"According to several research studies in the last decade, a total of 225,000 Americans per year have died as a result of their medical treatments:


• 12,000 deaths per year due to unnecessary surgery

• 7000 deaths per year due to medication errors in hospitals
• 20,000 deaths per year due to other errors in hospitals
• 80,000 deaths per year due to infections in hospitals
• 106,000 deaths per year due to negative effects of drugs
Thus, America's healthcare-system-induced deaths are the third leading cause of the death in the U.S., after heart disease and cancer.

Where am I getting all these disturbing statistics?  From the Journal of the American Medical Association, that den of alternative radicalism (seriously, one of the most conservative medical journals on the planet).  Here's the data written out at a radical blog and here's -WAIT-where is that pesky journal article?  Oh, right here on the JAMA website.  Oh, and if you had some concerns about Starfield's credentials, she works at John Hopkins.  So that's where we get our statistics. 

If you'd like a whole book on our chilling reality, check out Money Driven Medicine.

Friday, April 15, 2011

Differentiating between Naturopaths and Naturopathic Physicians.

For anyone not involved in the field, it can be incredibly difficult to differentiate the relative training and authenticity of degrees within alternative medicine.  Let me say that within all of medicine, it matters far more how ethical the person is than what degree they have. We all know stories of top ranked surgeons who have failed to practice ethically, and relative laypeople provide the backbone of much of our hospice and homecare structures.  So the degree doesn't matter in one sense.  But in another sense it really does matter, especially when it becomes the focus. 

Here's the information on Robert Theil.  "He is not a medical doctor, but is registered as a naturopath by the Federal District of Columbia, licensed as a Naturopath by the State of North Carolina, licensed as a Naturopathic Scientist by the State of Alabama and is licensed as a Naturopathic Physician by Bingham County, Idaho." 

Wow!  So if I were anyone other than who I am, I would think this guy is a naturopathic doctor, same as doc maloney.  Well, no.  Every place that he lists happens to not require a four year degree, boards, etc.  So he didn't go to Naturopathic medical school.  It doesn't mean he's a bad person, just that he's not licensed. 

In fact, the organization that Robert Thiel is a major member of, the American Naturopathic Medical Association, is the one fighting licensing and the medicalization of Naturopathy.  That's right, the ANMA is against the licensure of N.D.s  They run a program where you get a correspondence degree when you are board certified by the American Naturopathic Medical Certification and Accreditation Board.  Yep, they are board certified, not licensed.  It's kind of the cart without the horse, and if it seems confusing, it's meant to be.  It is this confusion, and the layering on of degrees without depth, that truly bothers me.  I have one degree, from one state, and it is more comprehensive than I can hope to master in my lifetime.  I can't imagine trying to fully master a variety of degrees from a variety of states. 

So a traditional Naturopath like Robert Thiel is not to be confused with the American Association of Naturopathic Physicians (http://www.naturopathic.org/) which is the professional group advocating for the licensure of N.D.s.  We all get licensed, and practice medicine, which includes diagnosing and treating disease.  In Maine, I do not use the term physician, but the term Naturopathic Doctor.  See http://maloneynd.tripod.com/naturopathicmaine/  But I was trained in Oregon, where we are Naturopathic Physicians. 

Now, I also saw a nice looking book from an English Naturopath, and I have no idea of her relative level of qualification.  It just shows the level of knowledge necessary to differentiate.  But it also matters what people do it their practices.  So, to show that differentiating does not mean discarding, have a look at both their books. 






Thursday, April 14, 2011

Why We Get Fat: It's the Carbs or our Genotype?

Gary Taubes has a new book that explains why we get fat.  Guess what?  It has nothing to do with calories.  Well, it does to some extent, but what should be obvious from the title of his previous work is that all calories are not equal.
So Taubes sets out to convince that calories alone do not explain our weight gain.  Then he progresses on to basically say:  meat is good.  Carbs are bad.  The first part is great the second part has yet to be proven (NY Times reviewer agrees.)

Ok, I'm already convinced that calories don't work.  But I'll also say that low carb is effective for only some people.  Yes, it is an answer for a very select subsection of the population.  But the rest of us do not need a blanket prescription for low carb.  We need to look at individual variation in food choices. 

The D'Adamos had at least a little variety, although they based it all on blood type, which is only one factor in individual makeup.  Now Peter D'Adamo has moved on to genotyping the diet, which is really cool and hopefully leads to more options.  But it isn't the genes, it's the histones.  They determine the activation of the genes.  So maybe I'll get a jump on everyone and start promoting the Histone Diet (patent pending).  Watch for it!  

By the way, Taubes Good Calories book does a number on a lot of diet myths.  It just concludes the way he wants it to conclude, because we don't have the perfect diet data yet. 

Wednesday, April 13, 2011

More information on radiation than you should want to read.



Wow, it just keeps getting more scary in Japan.  So here's a whole range of resources for those of you who are busy watching it real time and hearing about it on the news. 

First, take a minute to check the EPA's up-to-date radiation readings for your area.  (When are they going to start adding this to the weather report?)

Then, take a few moments to read what the National Institutes of Health has to say about radiation exposure. 

If you're more of a visual person, here is a fun (in a gallows humor sort of way) way to visualize your relative exposures to radiation

As I've pointed out at alternative health answers and at my website, the ionizing radiation you receive from medical testing is likely to far outweigh your exposure from Japan. 

If we take that idea to the next level, there is a whole group that irradiates people for a living.  Radiation oncologists specialize in treating you with radiation.  They just celebrated a century of using radiation as a treatment for cancer.  If you look at the second abstract, in many cases radiation therapy is the only available treatment.  The doses being used to palliate suffering are astronomically higher than anything we see anywhere else. 

If you look at the third abstract, in cases of advanced head and neck cancer the application of radiation in huge doses directly to the area is often not sufficient to cause hypothyroidism.  We're talking about extraordinary exposure, and still the body keeps on ticking.  It's a wonderful thing. 


If you are still panting for more information on radiation,  I've attached links to three books on the subject.  Bring your medical dictionaries and dig in.  Or maybe take a walk outside and breathe easy. 

Nat Rev Cancer. 2004 Sep;4(9):737-47.



Radiation oncology: a century of achievements.

Bernier J, Hall EJ, Giaccia A.

Department of Radio-Oncology, Oncology Institute of Southern Switzerland, CH-6504 Bellinzona, Switzerland. jacques.bernier@hcuge.ch



Abstract

Over the twentieth century the discipline of radiation oncology has developed from an experimental application of X-rays to a highly sophisticated treatment of cancer. Experts from many disciplines - chiefly clinicians, physicists and biologists - have contributed to these advances. Whereas the emphasis in the past was on refining techniques to ensure the accurate delivery of radiation, the future of radiation oncology lies in exploiting the genetics or the microenvironment of the tumour to turn cancer from an acute disease to a chronic disease that can be treated effectively with radiation.

PMID: 15343280


Radiother Oncol. 2011 Mar;98(3):287-91.

Palliative radiotherapy for cervical carcinoma, a systematic review.

van Lonkhuijzen L, Thomas G.

Odette Cancer Centre, ON, Canada.

Abstract

Purpose: Worldwide, particularly in developing countries, many women present with advanced stage cervical cancer for which palliative radiotherapy is the treatment of choice or may be the only available treatment. The purpose of this study was to determine from the literature the optimal palliative radiation scheme for the treatment of advanced cervical cancer. Design: A systematic literature review up to January 2010 was performed in Medline, Embase, the Cochrane database, CinHL and Google Scholar using a combination of synonyms for: cervical cancer, palliative treatment and radiation therapy. No limitations were applied for language or study types. For included papers data were extracted and described. Results: Only eight papers were identified and none compared the results of different fractionation schemes. Most used observational retrospective study design with considerable sources of bias. No studies used validated endpoints for symptom relief nor did they include measures of the quality of life. Several papers described the experience with single or multiple monthly 10Gy doses or with a higher total dose delivered in 2-4 fractions within 48h to 1week. Studies report varying amounts of relief from bleeding. The effect on other symptoms such as pain and discharge is not evaluable. Acute and late toxicity is poorly documented. Conclusion: There is a dearth of information in the current literature to guide selection of an optimal palliative radiation schedule for treatment of patients with advanced cervical cancer. Based on this review and information from other solid tumors, there is no evidence to support the common belief that better and longer palliation is achieved with a high dose delivered in multiple smaller fractions. There is a clear need for comparative studies of different radiation fractionation schedules in order to identify an optimal palliative radiation scheme. These studies require the use of validated endpoints to measure specific symptom relief as well as accompanying quality of life.

Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

PMID: 21316785

Radiother Oncol. 2011 Apr 1. [Epub ahead of print]

Radiation-induced hypothyroidism in head and neck cancer patients: A systematic review.

Boomsma MJ, Bijl HP, Langendijk JA.

Department of Radiation Oncology, University Medical Center Groningen, The Netherlands.

Abstract

PURPOSE: To review literature on the relationship between the dose distribution in the thyroid gland and the incidence of radiation-induced hypothyroidism in adults.

MATERIAL AND METHODS: Articles were identified through a search in MEDLINE, EMBASE and the Cochrane Library. Approximately 2449 articles were screened and selected by inclusion- and exclusion criteria. Eventually, there were five papers that fulfilled the eligibility criteria to be included in this review.

RESULTS: The sample sizes of the reviewed studies vary from 57 to 390 patients. The incidence of hypothyroidism was much higher (23-53%) than would be expected in a non-irradiated cohort. There was a large heterogeneity between the studies regarding study design, estimation of the dose to the thyroid gland and definition of endpoints. In general, the relationship between thyroid gland volume absorbing 10-70Gy (V10-V70), mean dose (Dmean), minimal dose (Dmin), maximum dose (Dmax) and point doses with hypothyroidism were analysed. An association between dose-volume parameters and hypothyroidism was found in two studies.

CONCLUSIONS: Hypothyroidism is frequently observed after radiation. Although the results suggest that higher radiation doses to the thyroid gland are associated with hypothyroidism, it was not possible to define a clear threshold radiation dose for the thyroid gland.

Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

PMID: 21459468



 

Friday, April 8, 2011

A primer on radiation of all types.

Paul Herscu has prepared a nice primer for everyone on radiation of all types.  Spoiler:  stop smoking and check for radon before you buy iodide. 

In lighter reading, Amy Rothenberg has written a book on cured cases from Natural Medicine.  She loves Oliver Sachs, so we should get lots of good stories.  Look at the book here.

Thursday, April 7, 2011

Hiroshima: The Last Japanese Nuclear Crisis.

For anyone watching the news it is important to realize that for many older Japanese this is the worst nuclear disaster since the bomb was dropped on them.  Even as we support them in this crisis, it is important to realize that many of them may be experiencing PTSD as an aspect of this crisis.

I wonder if we worried about our radiation exposure back then?  Were we even checking radiation levels?  It is somewhat ironic that we were likely the recipients of much of that blown radiation.    

Wednesday, April 6, 2011

Journal Article on Harmful Herbs in Liver Foundation Magazine.

I was really excited to have my herbs that harm article finally published.  Have a look at the American Liver Foundation website (I'm on page 26). 

Monday, April 4, 2011

How Many Ways Can We Say: Eat Well, Exercise, and Do It For Life?

Evidently we can say it to the tune of $48.7 billions dollars.  That's with a B, not an M, and that was for 2005 alone.  According to Forbes, lots of good diets exist.  There are many sites out there to rate the different diets, including those with reviews of the different diets.  I like the one I linked to because it focuses on the safety of diet plans.  A number of diets out there are just not a great idea in terms of your health. 

The most effective diet book I've ever read isn't a diet book at all.  It's the China Study, which goes over in detail the largest study ever done on diet and cancer.  The first part is intense because of his studies on rats and cancer production.  If you don't like that stuff, skip ahead to the huge studies on the Han Chinese, which provides conclusive evidence that diet activates or deactivates cancer. 

I guess the most disturbing thing about the book is that we haven't really shifted our diets to conform to what he found.  This was the big one.  I think they had 500,000 survey takers, and covered millions of people.  To paraphrase what he found, Campbell is now a vegan.  To give that context, he began life as a cattleman researcher, trying to find ways to increase our meat yields.  I still struggle to get my mind around what he found, and I still don't follow his diet.  But I keep trying, which is more than I can say of any other diet book I've read from years ago. 

Saturday, April 2, 2011

HCG Diet: Boy, I Wish I Could Get Behind It, But I Can't.

For those of you living in seclusion, the HCG diet is a great new craze.  Thank Kevin Trudeau, who publicized his own weight loss using the diet. 

Now, the basis of the HCG diet is a five hundred calorie diet.  Guess what, that's effective.  Starvation does actually lead to weight loss.  But the next step is to inject yourself with HCG.  For the men out there, this is the stuff that pregnant ladies generate.  And you'll be injecting that into yourself.  Hence my initial difficulty with the concept.

So does the HCG do anything?  Well, no.  It really doesn't.  Don't believe the experts, don't believe common sense.  Just have a look at the double blind, placebo controlled study.

S Afr Med J. 1990 Feb 17;77(4):185-9.
Human chorionic gonadotrophin and weight loss. A double-blind, placebo-controlled trial.

Bosch B, Venter I, Stewart RI, Bertram SR.
Department of Medical Physiology and Biochemistry, University of Stellenbosch, Parowvallei, CP.
Abstract

Low-dose human chorionic gonadotrophin (HCG) combined with a severe diet remains a popular treatment for obesity, despite equivocal evidence of its effectiveness. In a double-blind, placebo-controlled study, the effects of HCG on weight loss were compared with placebo injections. Forty obese women (body mass index greater than 30 kg/m2) were placed on the same diet supplying 5,000 kJ per day and received daily intramuscular injections of saline or HCG, 6 days a week for 6 weeks. A psychological profile, hunger level, body circumferences, a fasting blood sample and food records were obtained at the start and end of the study, while body weight was measured weekly. Subjects receiving HCG injections showed no advantages over those on placebo in respect of any of the variables recorded. Furthermore, weight loss on our diet was similar to that on severely restricted intake. We conclude that there is no rationale for the use of HCG injections in the treatment of obesity.
PMID: 2405506 [PubMed - indexed for MEDLINE]

So, while I'd love to have lots of patients and put them all on HCG, it hasn't been shown to work.  Starvation does work short term, but it generates long term problems.  As you generate a deficiency in the body, you are telling the fat cells that are left to become more active.  Fat is not just passive storage.  It works for your body by generating a range of hormones. 

BMC Med. 2011 Mar 16;9(1):25. [Epub ahead of print]


Regulation of vascular tone by adipocytes.

Maenhaut N, Van de Voorde J.
Abstract

ABSTRACT: Recent studies have shown that adipose tissue is an active endocrine and paracrine organ secreting several mediators called adipokines. Adipokines include hormones, inflammatory cytokines and other proteins. In obesity, adipose tissue becomes dysfunctional, resulting in an overproduction of proinflammatory adipokines and a lower production of anti-inflammatory adipokines. The pathological accumulation of dysfunctional adipose tissue that characterizes obesity is a major risk factor for many other diseases, including type 2 diabetes, cardiovascular disease and hypertension. Multiple physiological roles have been assigned to adipokines, including the regulation of vascular tone. For example, the unidentified adipocyte-derived relaxing factor (ADRF) released from adipose tissue has been shown to relax arteries. Besides ADRF, other adipokines such as adiponectin, omentin and visfatin are vasorelaxants. On the other hand, angiotensin II and resistin are vasoconstrictors released by adipocytes. Reactive oxygen species, leptin, tumour necrosis factor alpha, interleukin-6 and apelin share both vasorelaxing and constricting properties. Dysregulated synthesis of the vasoactive and proinflammatory adipokines may underlie the compromised vascular reactivity in obesity and obesity-related disorders.
PMID: 21410966

The bottom line is that I've just talked myself out of a whole bunch of patients looking for a quick weight loss solution.  But that's not what I want to do with patients.  What I want for patients is not term weight control, not just short term weight loss.  For that we have to use the body's wisdom to help people figure out what works for them. 

Kathryn Retzler of Hormone Synergy has done a wonderful job of summarizing the data on HCG.  http://www.hormonesynergy.com/resources.asp.  I hope she publishes her position paper, because we need people to understand the whole picture about HCG. 




Homeopathy: Boy, It Makes the Pharma Boys Quake.

Imagine, just imagine, that we had a process whereby we could take a single bottle of aspirin and use it to treat every single person on the planet.  Where we could orally vaccinate an entire third world country for a tenth of the cost.  Where families that could not afford medications for their dying children could receive medications for free.  Not donated by a charity, for free because the cost of producing the medication is so low that it can be given away by other families for free.  Wouldn't that be a good thing? 

Not if you want to make money, it wouldn't.  Hence the amazing resistance to homeopathy, and the perpetual attacks upon it.  If homeopathy replaced pharmaceuticals in even a small area, the billions saved would make the whole world sit up and take notice.  We'd have a roll-back to patients preparing their own remedies, a drop-off in surgeries and office visits, and a significant decrease in the total dollars spent on health care.  Most importantly, we'd finally see the huge hole in the logic that the "cure" for anything is a pharmaceutical.  Pharmaceuticals primarily manage, they rarely cure. 

 I got to read another salvo from Dr. Steven Novella recently.  He's upset because Dr. Oz has a TV show and he doesn't.  So he attacks Dr. Oz's credibility and insults his wife.  It's sort of disturbing, but since Dr. Novella works for Yale as a professional skeptic/neurologist I suppose we should assume he's well balanced. 

So here's a nice video of that supposed quack Dr. Oz washing up for surgery.  Compare him to his critic lower down. 

I do wonder what Dr. Novella will do with the upcoming radio show for Dana Ullman, author of the Homeopathic Revolution.  I imagine a bit of frothing at the mouth, following by some eye twitching.  All in a day's work for a professional skeptic.  I can only imagine that they must run shrieking from the aisles of supplements filling every supermarket, hunkering down in the canned goods aisles and filling their baskets with conservative choices like Spam and Twinkies.  At the checkout line they have to avert their eyes from every magazine, all trumpeting alternative treatments.  It's a lonely life, somewhat of a hermetic existance, and the nightly flagellation in penance for enjoying aromatherapy candles or a nice long bath has to get a bit wearing. 

That most skeptics are men is telling.  They also must be clueless men, because in all likelihood their spouses are merrily buying all the soaps and supplements they desire.  So these men, unable to bring their version of truth into the home,  seek solace with other men online.  What they are really saying is the world isn't going my way and I don't like it.  It is fortunate that the women of the world are running things, because for these guys anything beyond the stone scapel and a rock to bite on is too newfangled to be trusted.

For some basic research about homeopathy, please have a look at http://www.maloneymedical.com/id30.html  

Friday, April 1, 2011

Running in the Right Direction: A Run For Naturopathic Medicine.

A Naturopathic Doctor is planning to run across the U.S. to raise awareness of Naturopathic Medicine.  You can read all about it at:  http://physicianswholisten.blogspot.com/2011/03/running-for-naturopathic-medicine.html

Thursday, March 31, 2011

Tim Hawkins Makes Me Laugh Until I Cry With A Bible Verse: Check it out!

I cannot believe he manages to make a psalm funny, but he does. 

Tim Hawkins: Things You Don't Say To Your Wife.




For those of you who have no current partner, listen up!  But for the rest of us, this is just too true!  You'd think we'd have a course or something.  Maybe a class in high school?  Maybe a master's degree in how to talk to your partner without dying?    

Wednesday, March 30, 2011

A Diet Book I Like: The New ME Diet.

The Tetas have hit upon the metabolic effect, which allows you do exercise more intensely for shorter periods.  This is the focus of the book.  Dietary advice is basically South Beach/Atkins, and the exercises are not strenuous enough to get the kind of metabolic enhancement you really want. 

To get a sense of the actual workouts, here's one of the authors doing the workout. 
For those of you looking at weight loss:  have a look at the weight charts.  It's disturbing to see those numbers and realize they added five pounds for clothing (they also took away an inch for shoes). 

Tuesday, March 29, 2011

Career Advice and Talk About Her Sex Life, Meet Penelope Trunk.

I am one of the few people I know who own both Tim Ferriss' book and Penelope Trunk's first book.  Penelope is a writer on careers who also adds in frank information on her sex life without batting an eyelid.  She has a new book out, self-published, hand numbered, and signed until the 29th of March. 

I found her information on self-publishing very interesting.  Since she has 50,000 subscribers, it makes sense that she should self-publish.  

By the way, Penelope's first book was all about careers.  Nothing about her sex life.  I have a feeling that's why it didn't sell as well as it should.  She also doesn't rely on any pity for her diagnosed Aspergers, which is both admirable and an interesting choice. 

Monday, March 28, 2011

Ernst Reporting On Colic Alternatives.

Since I can link to Amazon easily from Blogger, I thought I would provide a link to Ernst's book.  He's not an objective observer of alternative medicine, he's one of the outspoken skeptics.  So his reporting on studies involving alternative medicine should not be taken as definitive.  Here's my other report on colic, and my webpage showing his review, a previous review by the same journal, and the evidence in support of alternative medicine. 

Sunday, March 27, 2011

Hypertension: White Coat Syndrome Medline Studies.

I realized that many of my readers may not wish to search for the literature on the previous post.  Here are the relevant medical studies with the pertinent information bolded.  Please print out and take with you to start a discussion with your prescribing doctor if you are not currently basing treatment on home pressure readings. 

To your health!

Clin Exp Hypertens. 2009 Jun;31(4):306-15.


White coat effect and its clinical implications in the elderly.

Yavuz BB, Yavuz B, Tayfur O, Cankurtaran M, Halil M, Ulger Z, Aytemir K, Kabakci G, Oto A, Ariogul S.

Hacettepe University Faculty of Medicine, Department of Internal Medicine, Division of Geriatric Medicine, Ankara, Turkey. bbyavuz@hacettepe.edu.tr

The aim of this study was to investigate the frequency and correlated factors of white coat effect (WCE) in the elderly. Geriatric patients who were known as normotensive and office BP exceeding 140/90 mmHg underwent 24-hour ambulatory blood pressure monitoring (ABPM). Correlation of WCE with clinical parameters, geriatric assessment scales, co-existing diseases, and laboratory results were analyzed. Within 61 patients 72.1% were diagnosed as white coat hypertension (WCH). Independent correlates of systolic WCE were activities of daily living, instrumental activities of daily living scores, creatinine; independent correlate of diastolic WCE was Geriatric Depression Scale score. White coat hypertension constitutes a major part of office-detected hypertension in geriatric patients. Ambulatory blood pressure monitoring should be performed on geriatric patients with office-measured hypertension in order to avoid overtreatment.

PMID: 19811359

Rev Port Cardiol. 1999 Oct;18(10):897-906.

[Arterial hypertension difficult to control in the elderly patient. The significance of the "white coat effect"]

[Article in Portuguese]

Amado P, Vasconcelos N, Santos I, Almeida L, Nazaré J, Carmona J.

Serviço de Cardiologia, Hospital Egas Moniz, Lisboa.

OBJECTIVE: Previous studies have revealed a high prevalence of white coat effect among treated hypertensive patients. The difference between clinic and ambulatory blood pressure seems to be more pronounced in older patients. This abnormal rise in blood pressure BP in treated hypertensive patients can lead to a misdiagnosis of refractory hypertension. Clinicians may increase the dosage of antihypertensive drugs or add further medication, increasing costs and producing harmful secondary effects. Our aim was to evaluate the discrepancy between clinic and ambulatory blood pressure in hypertensive patients on adequate antihypertensive treatment and to analyse the magnitude of the white coat effect and its relationship with age, gender, clinic blood pressure and cardiovascular or cerebrovascular events. POPULATION AND METHODS: We included 50 consecutive moderate/severe hypertensive patients, 58% female, mean age 68 +/- 10 years (48-88), clinic blood pressure (3 visits) > 160/90 mm Hg, on antihypertensive adequate treatment > 2 months with good compliance and without pseudohypertension. The patients were submitted to clinical evaluation (risk score), clinic blood pressure and heart rate, electrocardiogram and ambulatory blood pressure monitoring (Spacelabs 90,207). Systolic and diastolic 24 hour, daytime, night-time blood pressure and heart rate were recorded. We considered elderly patients above 60 years of age (80%). We defined white coat effect as the difference between systolic clinic blood pressure and daytime systolic blood pressure BP > 20 mm Hg or the difference between diastolic clinic blood pressure and daytime diastolic blood pressure > 10 mm Hg and severe white coat effect as systolic clinic blood pressure--daytime systolic blood pressure > 40 mm Hg or diastolic clinic blood pressure--daytime diastolic blood pressure > 20 mm Hg. The patients were asked to take blood pressure measurements out of hospital (at home or by a nurse). The majority of them performed an echocardiogram examination. RESULTS: Clinic blood pressure was significantly different from daytime ambulatory blood pressure (189 +/- 19/96 +/- 13 vs 139 +/- 18/78 +/- 10 mm Hg, p < 0.005). The magnitude of white coat effect was 50 +/- 17 (8-84) mm Hg for systolic blood pressure and 18 +/- 11 (-9 +/- 41) mm Hg for diastolic blood pressure. A marked white coat effect (> 40 mm Hg) was observed in 78% of our hypertensive patients. In elderly people (> 60 years), this difference was greater (50 +/- 15 vs 45 +/- 21 mm Hg) though not significantly. We did not find significant differences between sexes (males 54 +/- 16 mm Hg vs 48 +/- 17 mm Hg). In 66% of these patients, ambulatory blood pressure monitoring showed daytime blood pressure values < 140/90 mm Hg, therefore refractory hypertension was excluded. In 8 patients (18%) there was a previous history of ischemic cardiovascular or cerebrovascular disease and all of them had a marked difference between systolic clinic and daytime blood pressure (> 40 mm Hg). Blood pressure measurements performed out of hospital did not help clinicians to identify this phenomena as only 16% were similar (+/- 5 mm Hg) to ambulatory daytime values. CONCLUSIONS: Some hypertensive patients, on adequate antihypertensive treatment, have a significant difference between clinic blood pressure and ambulatory blood pressure measurements. This difference (White Coat Effect) is greater in elderly patients and in men (NS). Although clinic blood pressure values were significantly increased, the majority of these patients have controlled blood pressure on ambulatory monitoring. In this population, ambulatory blood pressure monitoring was of great value to identify a misdiagnosis of refractory hypertension, which could lead to improper decisions in the therapeutic management of elderly patients (increasing treatment) and compromise cerebrovascular or coronary circulation.

PMID: 10590654

Hypertension: Only Home Readings Count! Do Not Start Meds Based on Office Readings.

One of the most determined focuses in medicine today is the need to control blood pressure.  If I preface my taking of the readings with a short discussion of stroke risk, I can be sure to provide my patient with transient hypertension.  Once one elevated pressure is recorded, the patient is likely to experience anxiety about future readings and I am likely to be able to "confirm" the patient has hypertension in the office. 

Internationally this situation is recognized as "white coat syndrome."  Andrew Weil has a nice piece on the current state of the literature:  http://www.drweilblog.com/home/2011/3/27/why-you-should-check-your-blood-pressure-at-home.html  At this point if you are not doing home blood pressure readings, then you aren't getting the care you need.  I say this because I have patients who's home blood pressure is dropping too low, and others whose blood pressure is controlled only sometimes. 

The aggressive treatment of hypertension is focused on preventing stroke, but we haven't been terribly effective.  I suspect part of the cause is that we aren't effectively controlling blood pressure for many individuals.  Home readings done over weeks often spike when home stresses increase despite all the medications.  The body accommodates to the medication, and overrides it. 

The underlying cause is the stress of life, and we need to focus more on helping individuals deal with those stresses.  Once the stress is past, we need to help patients "re-set" to lower blood pressure.

For the studies on hypertension, have a look at the literature at:  http://www.maloneymedical.com/id63.html

Saturday, March 26, 2011

Osteoporosis: Beyond The Drugs, What Can We Do to Retain Bones?

We need to move beyond the calcium supplementation to addressing the core issues of osteoporosis.  It should be possible to alter the bone loss without resorting to lifelong estrogen replacement.  Some day we will treat this illness with comprehensive lifestyle changes, supplements, drugs, and hormonal balancing.

I've put some ideas about conservative treatments at: http://www.maloneymedical.com/id10.html

If patients were only encouraged to take specific exercise programs (extension, not contraction) we'd see less fracturing.