Wednesday, July 15, 2015


Dr Gislason wrote: "Selfcare only works if you have adequate knowledge and effective problem solving strategies. In the best case, you would know enough about your body functions to interpret symptoms as they arise and you would take corrective action. You would develop a good sense of what problems you can manage yourself and you would know when to seek help. You would use all the preventive strategies available to you and would use screening tests to detect early stages of disease. I have written several books on specific diseases with the idea of presenting adequate knowledge and suggesting problem solving strategies."

The Alpha Nutrition Program is a rational plan that requires new learning, discipline and self-control.  A basic intention is to do a better job of self-regulating. Self-regulation implies control over behavior. I learned by watching a few thousand people attempt to do this program that people with some measure of self-control were uncommon. I learned that self-discipline was in short supply and that rational plans tended to fail without a lot of support. Since eating is a social activity, changes in eating habits require a social method. 

Some exceptional people live well-organized lives with traditional lifestyle eating habits and operate from an internal locus of control that gives them an enviable ability to self-manage. If you have a well-developed center, you have an easier time developing new patterns, once you accept that it is necessary and desirable to change. You can plan an orderly transition from old to new. People with a strong internal locus of control are more skilled at collecting and evaluating information. They accept professional advice as information, not as parental authority. They tend to feel more confident making their own decisions."

Interface with MDs

For many years, we have proposed a collaborative relationship between patient and physician. The growth of medical information in the internet gives every intelligent person access to current information and to a variety of options. Often a patient with a specific disease is better informed than the physician. Carolyn Clancy, director of the US Agency for Healthcare Research and Quality stated: Patients are becoming more involved in decisions about their care. Even though this is a major change to how we (MDs) practice medicine, it will, over time, create a genuine partnership between doctors and patients. We recognize the importance of clear, ongoing communication, including questioning why a particular treatment decision was made. We need to engage our patients in the same way. My agency has developed a new public awareness campaign with the Ad Council to encourage patients to take a more active role in their healthcare.

A Free Copy of the book Self Care for the 21st Century is available as a PDF file for download.

Tuesday, July 14, 2015

Narcotic Drugs Addiction and Death

Narcotic drugs have always been associated with addiction; however, narcotic drugs remain the best agents to relieve pain. Pain management is the reason people are most likely to seek medical attention. Physicians try to balance their desire to elevate suffering against concerns that the patient in pain just wants a drug prescription. Physicians remain constrained by problems of drug dependence and addiction and are reluctant to prescribe narcotics or prescribe weak, inferior narcotics such as codeine and demerol. 
Weintstein et al polled 386 physicians in Texas and found that a significant number of physicians had prejudice against the use of opioid analgesics, displayed lack of knowledge about pain and its treatment, and had negative views about patients with chronic pain. They suggested that new educational strategies are needed to improve pain treatment in medical practice.  
 The narcotics that are considered to have the greatest addiction potential include codeine 60 mg, oxycodone, methadone, hydromorphone, demerol (meperidine), fentanyl, and morphine. The World Health Organization (WHO) suggested a progressive treatment of pain. For mild pain: aspirin, acetaminophen, nonsteroidal anti-inflammatory drugs and adjuvants. For moderate pain: mild opioids. For severe pain: traditional opioids. Physician concerns are justified. Narcotic-dependent people routinely solicit prescriptions from a number of physicians and become good at feigning painful conditions. Every primary care physician will have patients who tend to demand prescriptions for pain relievers and other psychotropic drugs and will become chronic users, unless the physician steadfastly resists their demands and limits prescriptions to short term use. 

Prescribed narcotics are always available for sale on the street. Most originate with doctors who are lenient prescribers. Drug traffickers have lists of lenient Doctors who write narcotic prescriptions on demand for a fee.  Prescribed narcotics are always available for sale on the street. For example, about two million Americans have admitted taking OxyContin (oxycodone) illegitimately. The US Drug Enforcement Administration reported that it is one of the most abused prescription drugs. Another narcotic, hydrocodone also has a high potential for abuse. Hydrocodone, as a narcotic cough medicine, is one of the favorite drugs sought by recreational users when they visit emergency departments. Both drugs act on the opioid mu receptor which blocks the transmission of pain in the spinal cord.
In the USA OxyContin is a $1.5 billion per year product. A report in the New York times from rural Kentucky ( July 2004) provides a perspective on narcotic drug use: “Ever since prescription painkillers like OxyContin became the drugs of choice among dealers and addicts in Appalachia, the days of small-town pharmacists' dispensing medicines from behind an ordinary counter have become a quaint memory. Now many pharmacies have turned into virtual fortresses. Some have bars over the windows. The most sought-after drugs are stored in vaults. The pharmacists often work behind safety glass, and some have even armed themselves. Surveillance cameras and alarm systems monitor every spot. Dan Smoot, chief detective for Operation Unite, an anti-drug task force said that prescription drugs remained the top problem for police agencies in the mountains. Mr. Smoot recently led the largest drug raid in Kentucky history, arresting over 200 people on charges of buying or selling prescription drugs on the black market.” 

The muscle relaxer, carisoprodol (Soma) is another favorite street drug which contains a metabolite of meprobamate, an old tranquilizer. Taken with alcohol, Soma produces stupor or "Soma coma." Tramadol (Ultram) is a pain medication that can produce a mild euphoric state. Dextromethorphan is a cough suppressant found in many cough syrups, which produces a euphoric state when taken in large quantities and can produce visual hallucinations.    People who take opioid analgesics for many days will develop physical dependence and will suffer withdrawal effects if the drug is discontinued suddenly. Symptoms of withdrawal include drug cravings, muscle cramps, joint pains, anxiety, nausea and vomiting. Withdrawal is most intense following IV heroin use and is relatively milder after taking oral medications.

Fentanyl has become the most potent narcotic with the greatest danger in the form of sudden death. Gatehouse and Nancy reported on the tragic rise in Fentanyl deaths in Canada. They described:" Over the past few months, fentanyl has been making headlines across North America, as police discover more and more of it on the streets, and overdose deaths surge. Authorities in Alberta linked the drug to 120 fatalities in 2014, and 50 more in just the first two months of this year. In British Columbia, it killed almost 80 people in 2014, and was responsible for a quarter of all drug deaths, up from just five per cent in 2012. In Ontario, where 625 people died of opioid overdoses in 2013, fentanyl was involved in 133 of those cases and, each year, it now kills twice as many people as heroin. First developed by pharmaceutical trailblazer Paul Janssen in 1959, it was originally used as an anaesthetic under the brand name Sublimaze. The slow-release transdermal patches for chronic pain relief were introduced in the mid-1990s. Its dangers have also long been recognized. There have been a number of scholarly studies about all the doctors and nurses, especially anaesthesiologists, who have become addicted to it, and notable victims such as Jay Bennett, the late guitarist for Wilco, who died of an accidental fentanyl overdose in 2009 after being prescribed the patch for an old hip injury. And the drug’s illicit analogues—there are at least a dozen variations—have been killing people on the streets since the late 1970s, most infamously under the name “China White.”
The deeper story of the drug and its abuse is even more worrying. Police and health workers now face an unprecedented situation, with a burgeoning street trade in both the legitimate prescription patches and illicitly manufactured fentanyl—often sold in pill form and made to look like OxyContin, a far less powerful narcotic. The drug, also available in liquid and powder form, is increasingly being used to cut cocaine and heroin, dramatically boosting their potency, often with fatal consequences. Indeed, fentanyl seems to turning up almost everywhere you look. And it’s killing both inexperienced newbies and hardened addicts. The illicit fentanyl that’s currently flooding Canadian markets in pill form has more benign nicknames: greenies, green beans and green monsters (all references to its emerald hue). But that doesn’t make it any less deadly. Stamped as OxyContin, the fentanyl has been retailing for as little as $10 a pill—an indication of how cheap it is to manufacture, and how easy it is to obtain the raw material.
The big B.C. investigation in March turned up two industrial pill presses that were used to make the 29,000 tablets. Two of the 14 people arrested in associated raids in Alberta and Saskatchewan are “full-patch” members of the Hells Angels. A third man is the president of an affiliated motorcycle gang, the Fallen Saints.
Then there’s the other problem: the growing abuse of the legitimate pharmaceutical version of the drug. Prescriptions for high-dose painkillers have skyrocketed over the last 15 years. A study by a group of Ontario researchers, published last fall in Canadian Family Physician,  determined that Canadians are now the world’s biggest per capita consumers of legal opioids, with more than 30 million high-dose tablets and patches distributed every year. Such widespread availability of opioids inevitably leads to widespread abuse. A recent meta-analysis by an American Scientist, published in the journal Pain, found that the average rate of misuse of prescribed painkillers is around 25 per cent  and that one in 10 medical users ends up addicted. In recent years, it was OxyContin that was driving that trend, because it could easily be crushed and snorted. But, once governments forced the manufacturer to introduce a tamper-resistant formulation, called OxyNeo, to the Canadian market in early 2012, the preferred high quickly became fentanyl.
Dr. Karen Woodall, a toxicologist with the Ontario Centre of Forensic Sciences in Toronto, regularly testifies as an expert in fentanyl cases. She first noticed the drug in 2005 in the autopsy files that cross her desk. She later traced deaths as far back as 2002, mostly via people overdosing after chewing cut-up bits of patches—a particularly dangerous practice, since there’s no way to predict the quantity of the drug in each piece. “The big problem with fentanyl is that a lot of people who aren’t tolerant to the drug are taking it. And if you’re not tolerant, it’s a lot more likely to cause serious toxicity and even death,” she says. “It severely depresses breathing and the heart rate. Combined with alcohol or other drugs that slow the central nervous system, it becomes even more dangerous. It’s a serious issue, we’re seeing more and more deaths.”  

From The Human Brain by Stephen Gislason MD


Sunday, July 05, 2015


The study of immunology has revealed a complexity of immune cell types and prolific interactions that overwhelm even the experts. The emerging description of chemical signaling that occurs among immune cells and between immune cells and all other tissues of the body has become especially complicated. As the collected data become denser, even highly specialized researchers have difficulty visualizing what is actually occurring in a diseased body.

The MD examining a patient, using conventional medical tools, is hopelessly inadequate and does not understand what is really going on. Classifications and names have changed with advancing discoveries. There more than 30 members of the interleukin family, for example, subdivided into families. To make a complex matter simple, they can be sorted into pro-inflammatory and anti-inflammatory groups.

Cell Signals

Cytokines are soluble proteins that regulate immune responses. One idea is that cytokines are short range signals. For example, it was though that production in lymphoid tissues is tightly localized and signaling occurs between conjugate cells. Perona-Wright et al assessed cytokine signaling during infection by measuring in vivo phosphorylation of intracellular signal transducer and activator of transcription (STAT) proteins. They stated: We show that interferon-γ (IFN-γ) and interleukin 4 (IL-4) signaled to the majority of lymphocytes throughout the reactive lymph node and that IL-4 conditioning of naive, bystander cells was sufficient to override opposing T helper type 1 (TH1) polarization. Our results demonstrate that despite localized production, cytokines can permeate a lymph node and modify the majority of cells therein. Cytokine conditioning of bystander cells could provide a mechanism by which chronic worm infections subvert the host response to subsequent infections or vaccination attempts.

 Another idea is that cytokines provide long-range signalling and help to organize systemic responses to infection and injury. The nature series of scientific journals sponsors a data base that by 2006 listed over 3700 signaling proteins that carry messages among cells of the body. Dove described the state of signalling science: “Ask a cell biologist to explain signal transduction, and you are in for a long story. The science of understanding how individual cells sense their environments and respond to stimuli fills library shelves, occupies whole departments of colleges and inspires the careers of thousands of researchers around the world. Even so, the field sometimes seems woefully understaffed.

The advent of whole-genome sequencing and gene-expression profiling revealed what most biologists already suspected: we are just beginning to understand cell signaling. For example, cells rely heavily on surface receptor proteins to communicate with the outside world. Often, signals flows through receptors that are coupled to effector molecules called G proteins. Inside the cell, information flow often entails an enzyme finding a specific target protein and attaching or removing phosphates, lipid groups, or other chemical structures. The modified target commonly goes on to modify other targets and so on through baroque cascades of interactions.”

Scientists have described a bewildering complexity of cytokines and variable cytokine production in different humans. We know that humans are not created equal. One significant inequality lies in the ability to produce cytokines of different types. An individual’s cytokine profile will help to determine the response to antigen challenges, susceptibility to different diseases and the severity of the disease, once contracted. Advances in techniques of identifying ever larger numbers of signaling molecules have produced research papers dense with measurement data, often in a curious limbo, where the ephemeral dynamics of cell interactions are scarcely mentioned and not at all understood.

From Immunology Notes by Stephen Gislason MD