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.

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.

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. 

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

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. 



How Many of Us Have Read It?

I just read a fascinating article about how our Christianity in America has little to do with the Bible.  In the past I have questioned exactly how many people have taken to heart some of the new testament teachings of giving all they have to the poor.  When asked, my conservative father (one set of vows from being a monk) slid around the issue by discussing works vs. faith.  

So how many of us have read the bible through?  I admit to always skipping over the begats and moving again and again to the new testament, which is blessedly shorter than what comes before.  But estimates that the majority of Christians have not read the bible are very troubling.  Especially for the group that sees the Bible as the literal word of God (my too clever response is always "which translation?").  If I truly hung on every word as God's, I think I would have committed whole sections to memory and read through the whole every year.  As it is, at one time I knew the variations of the four gospels. 

When I look at Amazon for the holy bible, I get seventeen thousand books.  Somehow that does not lend itself to a single text, but rather a multitude of translations.  Many of these are not true to the original Greek.  I remember an extensive argument with a Baptist pastor over the meaning of second Timothy.  The Greek text differentiated between an overbearing person and someone who acted in a teaching capacity.  The English translation we were using did not.  At stake was whether women could teach Sunday school. 
I love the King James version, but I know full well that the translators went for the poetry of the work, not the literal translation.  It's still my favorite.  Second would be those texts that give Jesus' actual words in red.