While neurological diseases and “mental illnesses” appear to be a vast pool of suffering with diverse causes, mostly unknown, I continue to propose a simple and obvious approach to prevention and treatment of disease. I have written about nutritional programming (NP), an ambitious approach to diet design that addresses all the complicated issues of resolving health problems related to food intake, a form of molecular engineering or programming. Good, Fernandes and West stated in their review of Nutrition and Immunity many years ago: “We look forward to the time when the prophylactic and therapeutic potential of scientifically controlled diet, along with cellular, molecular, and hormonal engineering, may be realized and applied. Freedom of many disorders which have historically deprived us of our genetic legacy of a long and healthy life is certainly a worthwhile objective."
The food supply is critically important to brain function. There are many ideas which link food ingestion and the environment to brain dysfunction and disease. We can ask some simple questions to inspire further inquiry, such as: Are mental and neurological diseases diet related? Are the victims deficient in critical nutrients, or poisoned by excesses of nutrients? Are some dementias caused by the toxicity of food additives, pesticides and/or food contaminants? Do these diseases combine food toxicity and food allergy and emerge slowly in complex combinations? Do the most afflicted people drink more alcoholic beverages, tea, and coffee; eat more fast foods, cheese, bread, or meat? Where do they live? What environmental toxins are common in their food, water and air?
These and related questions about diet and disease have never been answered in terms of meaningful research; however, there are a thousand clues in the research literature which point to diverse problems and many potential solutions . My experience with food-related psychopathology suggests that modern diets are probably responsible for cerebrovascular disease, most strokes, all diabetic neuropathies, some learning and behavioral problems in children, some mental illness, some depressions, some dementias and some neurological disease of undefined origin. The mechanisms are of these disorders are multiple and complex.
You can imagine an alternative world. For example, what if no-one ate too much of the wrong food and everyone did physical work every day? What if the consumption of tobacco, caffeine and alcohol disappeared suddenly? Would you expect humans in general would feel and function better? Would babies be born healthier? Would babies’ brains work better?
What if packaged, processed, fast foods disappeared tomorrow and every child ate more fruits and vegetables? What if children took a balanced vitamin-mineral supplement everyday? Would all those children feel and function better? Would their IQ scores be higher? Would they do better in school? What if combustion engines were replaced by fuels cells converting hydrogen to water? There would be no toxic hydrocarbons, less carbon monoxide and less carbon dioxide.
What if vehicular traffic vanished from cities and paved areas were replaced with walking and cycling paths, gardens, orchards, and flowers? What if vegetables were grown in market gardens within cities where parking lots used to be? Would human brains work better? Would urbanites be healthier, happier and more productive? Why not continue imagining how you would construct an ideal world? You cannot imagine an ideal world without imagining an ideal diet and an ideal environment to live in.
Nutrition can be thought of as an idealized, abstract look at the possible (but not real) outcomes of eating food. The role of foods themselves, as objects of behavior and regulators of internal body dynamics, are relatively ignored. The possibility of things going wrong with digestion, absorption, and metabolism and with immune surveillance of these processes, while considered in medical science, is seldom a concern in medical practice. The dietitian often assumes that nothing will go wrong with food-body interactions - nutrients that are in the food are available to the body without complications. A physician generally assumes that nothing will go wrong during the processing of food or will consider a small number of adverse effects ignoring a number of pathological possibilities that may be the key to enigmatic disease.
To pursue a strategy of nutritional therapy, you assume that things routinely go wrong with food-body interactions. Since food ingestion creates dysfunction and disease by a variety of mechanisms, nutritional therapy is based on removing the causes of illness by correcting a faulty food supply. The supreme technique of nutritional therapy is, therefore, diet revision, a strategy of correcting disease by modifying food choices and eating behaviors.
Proper diet revision restores control over a confusing, chaotic set of circumstances and symptoms. A systematic method of diet revision with full participation of the patient in evaluating and selecting foods has never been included in medical practice. Efforts to change a patient’s food supply also encounter the irrational elements of eating behavior. Diet revision often turns into a struggle with fast foods, compulsive eating, emotional issues, family and societal issues.
The Alpha Nutrition Program evolved as a standard method of diet revision. The program should be viewed as a prototype that encourages the development of nutritional therapy as a systematic study. Since resolving delayed patterns of food allergy in common disorders such as eczema, migraine, asthma, and irritable bowel were priorities, this method of diet revision was influenced by allergy practice. The basic idea is to reduce or eliminate problem foods first. Once a patient clears their original symptoms, they have heightened reactivity and food challenges are more unpleasant, risky, and obvious.
Human Brain in Health and Disease by Stephen Gislason MD
Friday, April 23, 2010
Monday, April 05, 2010
Weight Loss Fantasy and Fraud
Thousands of weight loss schemes have been marketed -some sincere but flawed, others frankly fraudulent. Some estimates of cost suggest over 40 billion dollars a year is spent in the USA alone on retail products and schemes offered for weight loss while increasing numbers of people are becoming obese. Diet Plans such as the Atkins diet and the South Beach variants are pitched by persistent advertising and many people join the parade of followers. Some lose weight, but almost all regain the weight they lost.
Infomercials, shown on cable TV promise that you can lose all the weight you want while you eat everything you want are false and not to be believed. This is what everyone wants of, course, a quick cure, but there is no easy path. It doesn't matter what they are trying to sell you - crab shells (chitin), fat absorbers, fat burners, magic mushrooms, wonder bark from Brazil, magic cellulite pills, pyruvate, creatine, garcinia cambogia, green goop, algae, magic genies in a bottle - it's all a great fantasy that will not come true.
There is no magic diet. The medical community, food industry, dietitians government health and regulatory agencies, magazine publishers and diet businesses are all helpless as Americans and Canadians consume excessive amounts of food and become increasingly obese. This epidemic of obesity threatens to bankrupt the health care system in both countries. Weight loss products and claims appear to be out of control as regulatory agencies in the USA and Canada only made token attempts to stop fraud.
A new wave of "reality" shows on TV show people attempting to lose weight and reveal how difficult it is to lose, how hard you have to work, how much you have to change your food choices and how much you will depend on other people to support your effort. The simple truth is – it's easier to gain weight than to lose it. Research has shown several important features of body weight management. There are powerful biological controllers of eating behaviors, appetite and weight regulation. There are genetic tendencies toward excess weight and obesity-causing gene mutations have been discovered. European and North American diets are flawed. There is excess fat and sugar in "normal" foods and food is too abundant. Eating has become entertainment. This is a bad idea if you want to stay slim. The modern lifestyle is flawed. There is too much sitting, too much convenience and too little physical work. Recreational eating must be abandoned in favor of recreational exercise
Weight issues are usually discussed as individual problems. The reality is that obesity is an expanding global problem. Because overeating causes many diseases, this global problem is often described as a disease epidemic that spreads like an infectious disease. An intelligent approach to each individual who is overweight is to recognize that this one person is a member of a group whose members all participate in creating dysfunction and disease. Obesity can only be understood as a family problem and then a societal problem. Remedies do involve changes in the behavior of individuals but these changes depend on a supporting group that changes the way the community operates.
Fat storage has a purpose and offers benefits. Everyone stores some white fat to provide insulation and body shape. Our facial contours are constructed from fat. The shape of women’s bodies differ from men’s bodies because of carefully designed fat deposits in the breast, abdomen and buttocks. Extra fat is a good insulator and keeps you warm. Extra fat is buoyant and helps you float in water. Marine mammals are all fat because they swim in cold water. Eskimos are fat so that they can survive cold winters when food is scarce. Brown fat is a source of heat; calories are burned in brown fat to warm the body.
Children hear stories about prudent animals who prepare for the future and do well and imprudent animals who only live for the present and perish. The child knows that squirrels store nuts for the winter and bees survive the winter by eating the honey they made during the summer. Bears get fat in the summer so that they can hibernate during the winter. The challenge of a seasonal food supply is expressed in acquisitive behavior, gaining weight and hoarding food. Most humans seem to have an odd mixture of prudent and imprudent behaviors and only a small number appear to be good at long-term planning.
Humans are relatively tolerant of short-term food deprivation and take advantage of surplus by feasting and celebrating. The party aspect of human behavior links us strongly with carnivorous predators who gorge when they have made a kill and then rest. All overweight people would become slimmer if they hibernated over the winter and did not eat food for 4 months. All overweight people would become lean people if they as trained hard and long as an endurance cyclist. Long-distance athletes are the leanest people in town because sustained exertion causes muscle cells to use fat as fuel. If you train long enough and hard enough, most of your stored body fat is burned as fuel.
Diets Don't Work
Most therapists who have worked with overweight patients have stories of spectacular initial successes, with equally spectacular relapses weeks or months later. Obviously, there are unsolved problems in the weight-loss business. Carbohydrates are often blamed for weight gain and high fat, high protein diets have been promoted for 50 years and books proclaiming weight loss success are re-issued year after year without any reassurance that these diets are healthy or safe. Research in the 20th century showed that diets rich in plant foods and low in animal fat and proteins are the best diets for health from all points of view. The long-term consequences of high protein, high fat diets are well known; you get all the bad diseases that characterize modern civilization such as cancer, heart disease, strokes, diabetes and obesity.
This is not to argue that you could not lose weight on a high protein, high fat diet. You can lose weight by any method of reducing caloric intake, but that weight loss is not be relevant to your long-term success. It is to argue that you would be making a mistake if you lived on a high protein, high fat diet for many years. Pittas et al, for example, compared a high glycemic index, high-carbohydrate diet with a low-GI/low-carbohydrate diet resulted in comparable weight loss and increase in insulin sensitivity in 34 overweight participants. Both diets in the randomized, double-blind trial were designed to achieve 30% calorie restriction and followed recommendations for "healthy eating." The high carbohydrate diet was 60% carbohydrates, 20% protein, and 20% fat. The low-carbohydrate diet was 40% carbohydrates, 30% protein, and 30% fat. Both groups achieved a 10% reduction in BMI and 20% increase in insulin sensitivity. Dansinger et al. compared 4 popular diets (Atkins, Zone, Weight Watchers, and Ornish) for weight loss and cardiac risk factor reduction. and found that each diet modestly reduced body weight and several cardiac risk factors at 1 year. Overall dietary adherence rates were low. Increased adherence was associated with greater weight loss and cardiac risk factor reductions for each diet group.
Appetite and weight regulation are complex and vary from person to person. While there are some general rules, there are many exceptions to the rules. The solution to obesity, diabetes, high blood pressure, coronary artery disease lies more in the choice what foods you eat, how they are cooked, and how much you eat. The idea that you can predict the outcome of eating specific foods by the knowing the carbohydrate, fat, protein ratios is wrong. No matter what other argument seems appealing, the single enduring fact of healthy nutrition is that a diet rich in plant foods works best. Some plant foods such as wheat, however, may cause severe disease in people who are susceptible (as I am), so that no generalization will work for everyone.
Read More in Eating and Weight Management by Stephen Gislason MD
http://www.nutramed.com/AlphaBooks/EatingWeight_Managment.htm
Infomercials, shown on cable TV promise that you can lose all the weight you want while you eat everything you want are false and not to be believed. This is what everyone wants of, course, a quick cure, but there is no easy path. It doesn't matter what they are trying to sell you - crab shells (chitin), fat absorbers, fat burners, magic mushrooms, wonder bark from Brazil, magic cellulite pills, pyruvate, creatine, garcinia cambogia, green goop, algae, magic genies in a bottle - it's all a great fantasy that will not come true.
There is no magic diet. The medical community, food industry, dietitians government health and regulatory agencies, magazine publishers and diet businesses are all helpless as Americans and Canadians consume excessive amounts of food and become increasingly obese. This epidemic of obesity threatens to bankrupt the health care system in both countries. Weight loss products and claims appear to be out of control as regulatory agencies in the USA and Canada only made token attempts to stop fraud.
A new wave of "reality" shows on TV show people attempting to lose weight and reveal how difficult it is to lose, how hard you have to work, how much you have to change your food choices and how much you will depend on other people to support your effort. The simple truth is – it's easier to gain weight than to lose it. Research has shown several important features of body weight management. There are powerful biological controllers of eating behaviors, appetite and weight regulation. There are genetic tendencies toward excess weight and obesity-causing gene mutations have been discovered. European and North American diets are flawed. There is excess fat and sugar in "normal" foods and food is too abundant. Eating has become entertainment. This is a bad idea if you want to stay slim. The modern lifestyle is flawed. There is too much sitting, too much convenience and too little physical work. Recreational eating must be abandoned in favor of recreational exercise
Weight issues are usually discussed as individual problems. The reality is that obesity is an expanding global problem. Because overeating causes many diseases, this global problem is often described as a disease epidemic that spreads like an infectious disease. An intelligent approach to each individual who is overweight is to recognize that this one person is a member of a group whose members all participate in creating dysfunction and disease. Obesity can only be understood as a family problem and then a societal problem. Remedies do involve changes in the behavior of individuals but these changes depend on a supporting group that changes the way the community operates.
Fat storage has a purpose and offers benefits. Everyone stores some white fat to provide insulation and body shape. Our facial contours are constructed from fat. The shape of women’s bodies differ from men’s bodies because of carefully designed fat deposits in the breast, abdomen and buttocks. Extra fat is a good insulator and keeps you warm. Extra fat is buoyant and helps you float in water. Marine mammals are all fat because they swim in cold water. Eskimos are fat so that they can survive cold winters when food is scarce. Brown fat is a source of heat; calories are burned in brown fat to warm the body.
Children hear stories about prudent animals who prepare for the future and do well and imprudent animals who only live for the present and perish. The child knows that squirrels store nuts for the winter and bees survive the winter by eating the honey they made during the summer. Bears get fat in the summer so that they can hibernate during the winter. The challenge of a seasonal food supply is expressed in acquisitive behavior, gaining weight and hoarding food. Most humans seem to have an odd mixture of prudent and imprudent behaviors and only a small number appear to be good at long-term planning.
Humans are relatively tolerant of short-term food deprivation and take advantage of surplus by feasting and celebrating. The party aspect of human behavior links us strongly with carnivorous predators who gorge when they have made a kill and then rest. All overweight people would become slimmer if they hibernated over the winter and did not eat food for 4 months. All overweight people would become lean people if they as trained hard and long as an endurance cyclist. Long-distance athletes are the leanest people in town because sustained exertion causes muscle cells to use fat as fuel. If you train long enough and hard enough, most of your stored body fat is burned as fuel.
Diets Don't Work
Most therapists who have worked with overweight patients have stories of spectacular initial successes, with equally spectacular relapses weeks or months later. Obviously, there are unsolved problems in the weight-loss business. Carbohydrates are often blamed for weight gain and high fat, high protein diets have been promoted for 50 years and books proclaiming weight loss success are re-issued year after year without any reassurance that these diets are healthy or safe. Research in the 20th century showed that diets rich in plant foods and low in animal fat and proteins are the best diets for health from all points of view. The long-term consequences of high protein, high fat diets are well known; you get all the bad diseases that characterize modern civilization such as cancer, heart disease, strokes, diabetes and obesity.
This is not to argue that you could not lose weight on a high protein, high fat diet. You can lose weight by any method of reducing caloric intake, but that weight loss is not be relevant to your long-term success. It is to argue that you would be making a mistake if you lived on a high protein, high fat diet for many years. Pittas et al, for example, compared a high glycemic index, high-carbohydrate diet with a low-GI/low-carbohydrate diet resulted in comparable weight loss and increase in insulin sensitivity in 34 overweight participants. Both diets in the randomized, double-blind trial were designed to achieve 30% calorie restriction and followed recommendations for "healthy eating." The high carbohydrate diet was 60% carbohydrates, 20% protein, and 20% fat. The low-carbohydrate diet was 40% carbohydrates, 30% protein, and 30% fat. Both groups achieved a 10% reduction in BMI and 20% increase in insulin sensitivity. Dansinger et al. compared 4 popular diets (Atkins, Zone, Weight Watchers, and Ornish) for weight loss and cardiac risk factor reduction. and found that each diet modestly reduced body weight and several cardiac risk factors at 1 year. Overall dietary adherence rates were low. Increased adherence was associated with greater weight loss and cardiac risk factor reductions for each diet group.
Appetite and weight regulation are complex and vary from person to person. While there are some general rules, there are many exceptions to the rules. The solution to obesity, diabetes, high blood pressure, coronary artery disease lies more in the choice what foods you eat, how they are cooked, and how much you eat. The idea that you can predict the outcome of eating specific foods by the knowing the carbohydrate, fat, protein ratios is wrong. No matter what other argument seems appealing, the single enduring fact of healthy nutrition is that a diet rich in plant foods works best. Some plant foods such as wheat, however, may cause severe disease in people who are susceptible (as I am), so that no generalization will work for everyone.
Read More in Eating and Weight Management by Stephen Gislason MD
http://www.nutramed.com/AlphaBooks/EatingWeight_Managment.htm
Wednesday, December 23, 2009
Depression is Big Business
What is Depression ?
The term "depression" is descriptive and vague. I believe the whole concept of depression is flawed and needs to be revised. The term “depression” does not point to one discrete disorder but to a variety of unpleasant experiences common to all humans. When the term “depression” is used without qualification, it is usually misleading. Since antidepressant drugs have become a big business, the promotion of "depression" as a widespread illness, treatable with drugs has become a scandalous marketing enterprise with little or no merit. Although the term “depression” was an invention of psychiatry the use of the term is pervasive in medicine, the media and in folk psychology. Writers, TV journalist and MDs have been talking about “clinical depression” as if “clinical” increased the credibility of this dubious term. The best use of the term “depression’ is to point to someone who is unusually and chronically sad, critical and angry; a person who withdraws from work, play and close relationships with other humans.
There are eight circumstances that cause sadness, anger and sustained dysphoria:
1. The inhalation, ingestion and injection of bad chemicals
2. Chronic illness
3. Oppression and abuse
4. Wrong food
5. Too little exercise
6. Noise, clutter and poor living conditions
7. Information noise and confusion
8. Loss of persons, property and prestige
All humans are involved in competition and negotiation with other humans. If you are losing a competitive struggle, you feel, sad and angry, sometimes with a terrible sense of loss; you want to withdraw, hide, cry and sometimes you want to die. If you habitually lose competitions or have an effective oppressor close by, you often feel dysphoric. We can call this social inhibition, oppression or suppression rather than depression.
Physicians have routinely prescribed drugs to patients who were sad, discouraged and thought of suicide. None of the drugs prescribed have reduced the overall suicide rates and new evidence suggests that some antidepressants increase the risk of suicide. For patients who died of an overdose, the prescriptions took on the ominous aspect of tools of self-destruction. The prescribing physician becomes an accomplice in the patient’s death.
Antidepressants
Antidepressants were a hard sell until recently. Although many drugs in this class modified the behavior of patients, their slow action and many side effects were negative features. The introduction of a “new class” of antidepressants that increase serotonin activity, led by Prozac changed the market for psychotropic drugs. The effects of Prozac on “personality” were widely publicized and drug companies advertise indirectly and, more recently directly to the consumer, relegating physicians to the role of middleman. The patient now demands the prescription and the doctor complies. The consumer hopes that Prozac and related drugs can increase energy, confidence and assertiveness. “Shy” people were added to list of potential customers.
Although writers such as psychiatrist Peter Kramer (Listening to Prozac) suggested that the patient's interest in personality changing drugs was a new market force, nothing new really happened; it is the same old interest in psychotropic drugs but the names, the players and the prices changed. Cocaine outsells Prozac, but the profitability of prescription antidepressant drugs is outstanding.
Goodman, Chair of the US Food and Drug Administration (FDA) Psychopharmacologic Drugs Advisory Committee made a public statement in 2006 that claims in drug monographs and advertising that selective serotonin reuptake inhibitor (SSRI) antidepressants work by normalizing serotonin levels are not based on scientific evidence and should be prohibited. Moynihan and Cassels described the drug industry's marketing tactics. With obscene profits from drug sales; a drug company can afford to control the naming and perception of diseases by physicians, government, and consumers. They create drug demand by advertising to consumers and doctors at the same time. For example, Cohn & Wolfe Healthcare, SmithKline's PR firm created “social phobia disorder” treatable with Paxil, which became the world's best-selling antidepressant, earning US$3 billion annually.
Brain Drugs -- Benefit or Harm?
A review of data, just published, from the US Women's Health Initiative study (involving 136,293 postmenopausal women) revealed that , 5496 women taking drugs from the two major antidepressant groups, tricyclic antidepressants (TCI) and selective serotonin-reuptake inhibitors (SSRI), had increased all-cause mortality; SSRIs users had a 45% increased relative risk of incidence stroke and a 32% increased risk of death with a higher incidence of hemorrhagic strokes. The incidence of stroke per 1000 person-years with no antidepressant use was 2.99; the incidence for SSRI users was 4.16 for. Death rates for per 1000 person-years were 12.77 for SSRI users and 14.14 for TCI users, compared with 7.79 for non–antidepressant users. Studies of this nature cannot differentiate the negative effects of dugs from the underlying disease processes. In medical talk, depression has assumed a false reality, becoming a malevolent agent that acts upon its victim. While sad, tired and angry people are real, depression is not real and is not a cause of something else such as a stroke. My conclusion is that antidepressant drugs are potentially harmful and can add to the existing pathologies that they pretend to treat
Antidepressants are chemicals that are added to a dysfunctional chemical mix that caused dysfunction and dysphoria in the first place. Few patients make any effort to alter their disease-causing lifestyle and few physicians make any effort to investigate and improve the patient’s chemistry overall. Psychotropic drugs are added to the dysfunctional chemical mix and its effects merge with coffee, alcohol, the chemistry of food additives, and contaminants, sugars, food allergy and airborne neurotoxins that act on the brain.
New problems added by the prescription chemical may suddenly emerge such as unexpected bursts of anger and aggression or increased tendency to have violent suicidal thoughts. One young woman reported to me that after taking Prozac for two weeks, she had threatened her live-in boyfriend with hammer, chased him into the bathroom and attacked the closed door, smashing holes in the door until she more or less recovered composure. Her boyfriend fled the apartment and never returned. The boyfriend was domineering and verbally abusive, as boyfriends sometimes are, but the pre-Prozac young woman was usually compliant and never had a violent temper. Her Prozac rage is an example of chemically triggered behavior. Prozac may provoke agitated preoccupation with suicide or violence directed against others. The drug facilitates the rage response, as do most of the drugs that suppress appetite. Up to 73% of patients taking antidepressant report sexual dysfunction, such as diminished sexual desire, delayed sexual arousal, and muted or absent orgasm.
Fisher suggested that these drugs blunt emotions and interfere with forming and maintaining meaningful relationships. When men and women take serotonin-enhancing drugs and fail to achieve orgasm, an important feature of pair bonding fails. You would not be surprised to learn that a woman taking Prozac decided to divorce her husband, stating that she no longer loved him. After she stopped taking the drug, she loved him again and stayed married.
Prozac can facilitate the rage response and may lead to acts of aggression and violence that otherwise would not occur. Prozac also inhibits appetite for food and sexual appetites; sometime useful effects, but not always. In Canada, three similar antidepressants were among the top-selling drugs; these are Prozac, Paxil, and Zoloft. Lauren Slater called Prozac the "Big Mac of Medicine" because of its popularity and the faddish consumer appeal based on the futile hope that a drug could resolve human suffering. She described the dramatic and brief benefits of taking Prozac: "those first few mornings were fairy tales, tall tales, replete with all the bent beauty of a New World." Her story is not simple, however and the long-term effects of taking the drug are mixture of benefits and negative effects. The initial recovery from depression is not sustained and a three or four phase sequence can often be discerned, beginning with an initial improvement that occurs in the first 2 to 4 weeks. The statement “the first time was the best time" applies to most, if not to all psychotropic drugs.
In Slater's experience, Prozac removed her sexual drive, blunted her creativity and reduced her appetite. The underlying problems are many and begin with the lack of specificity of the drug. Prozac blocks Serotonin re-uptake and in stage 1 of its activity, probably increases serotonin receptor activity in all areas of the brain. Serotonin synapses are not all conveniently arranged just to alleviate depression and a whole complex of unrelated functions are affected. The brain is not passive and changes to offset or accommodate the drug activity; the effects then shift to an adapted state, different from the initial drug-dependent state. The person taking the drug has also shifted in terms of behavior and learning and may be learning new skills and, at the same time, coping with new problems such increased anger, loss of libido and blunted feelings.
Martin Enserink reviewed the development of antidepressant drugs and stated: ‘Antidepressants have evolved through several generations since the 1950s, each a “huge improvement” over its predecessor--or so advocates have claimed. But a government-sponsored study published last month confirmed what other analyses had shown before: The fashionable antidepressants of the 1990s are no more effective than those of previous generations. The study, a meta-analysis commissioned by the Agency for Health Care Policy and Research (a part of the Department of Health and Human Services, USA) and carried out by the Evidence Based Practice Center in San Antonio, Texas, looked at 315 studies carried out since 1980. It focused primarily on the hottest pills that have hit the market since 1987, the "selective serotonin reuptake inhibitors" (SSRIs), a group that includes such brands as Prozac, Paxil, and Zoloft. The study found that on average, about 50% of patients in SSRI treatment groups improved, compared to 32% in placebo groups. But in the more than 200 trials that compared new drugs with older ones, the two classes proved equally efficacious. Because the newer drugs appear to have less severe side effects, however, patients may be able to stay on them longer. The failure to find evidence of progress is disappointing, scientists admit. And one of the biggest disappointments is that researchers still don't understand what causes--or relieves--depression. Most antidepressant drugs are based on the assumption that depression results from a shortage of serotonin or norepinephrine in the brain. Both are neurotransmitters, chemical messengers that cross the synapse, the cleft between two nerve cells. The first generation of antidepressants, discovered during the early 1950s, the MAO inhibitors, block monoamine oxidase, an enzyme that breaks down serotonin and norepinephrine. This allows the neurotransmitters to linger in the synapse, increasing their effect. Another type of drug discovered in the late 1950s, the tricyclics, prevents the nerve cells that excrete the neurotransmitters from mopping up these compounds shortly after they are released. Blocking "reuptake" also prolongs their effect. Because studies pointed to serotonin shortage as the main culprit in depression, industry developed the selective reuptake inhibitors, which now dominate the market.”
Data from United Kingdom's General Practice Research Database of 6.4 million patients were used to discover a relationship between antidepressant use and diabetes 2: 165,958 patients were identified who received at least 1 new prescription for an antidepressant between January 1, 1990 and June 30, 2005. The researchers conclded that taking moderate to high daily doses of antidepressants for more than 2 years is associated with an 84% increased risk for diabetes.The increased risk was particularly notable for the selective serotonin reuptake inhibitor (SSRI) paroxetine and the tricyclic antidepressant amitriptyline. Another study, the Diabetes Prevention Program (DPP) trial found that antidepressant use over an average of 3.2 years was associated with an increased risk for diabetes of 2.60 in the placebo group and 3.39 in the lifestyle-intervention group, but there was no increased risk in the metformin group. Paroxetine caused a 4-fold increased risk for diabetes above 20 mg/day. Related drugs, fluoxetine, citalopram, or sertraline did not increase the risk.
From the book: The Human Brain in Health and Disease by Stephen Gislason MD
The term "depression" is descriptive and vague. I believe the whole concept of depression is flawed and needs to be revised. The term “depression” does not point to one discrete disorder but to a variety of unpleasant experiences common to all humans. When the term “depression” is used without qualification, it is usually misleading. Since antidepressant drugs have become a big business, the promotion of "depression" as a widespread illness, treatable with drugs has become a scandalous marketing enterprise with little or no merit. Although the term “depression” was an invention of psychiatry the use of the term is pervasive in medicine, the media and in folk psychology. Writers, TV journalist and MDs have been talking about “clinical depression” as if “clinical” increased the credibility of this dubious term. The best use of the term “depression’ is to point to someone who is unusually and chronically sad, critical and angry; a person who withdraws from work, play and close relationships with other humans.
There are eight circumstances that cause sadness, anger and sustained dysphoria:
1. The inhalation, ingestion and injection of bad chemicals
2. Chronic illness
3. Oppression and abuse
4. Wrong food
5. Too little exercise
6. Noise, clutter and poor living conditions
7. Information noise and confusion
8. Loss of persons, property and prestige
All humans are involved in competition and negotiation with other humans. If you are losing a competitive struggle, you feel, sad and angry, sometimes with a terrible sense of loss; you want to withdraw, hide, cry and sometimes you want to die. If you habitually lose competitions or have an effective oppressor close by, you often feel dysphoric. We can call this social inhibition, oppression or suppression rather than depression.
Physicians have routinely prescribed drugs to patients who were sad, discouraged and thought of suicide. None of the drugs prescribed have reduced the overall suicide rates and new evidence suggests that some antidepressants increase the risk of suicide. For patients who died of an overdose, the prescriptions took on the ominous aspect of tools of self-destruction. The prescribing physician becomes an accomplice in the patient’s death.
Antidepressants
Antidepressants were a hard sell until recently. Although many drugs in this class modified the behavior of patients, their slow action and many side effects were negative features. The introduction of a “new class” of antidepressants that increase serotonin activity, led by Prozac changed the market for psychotropic drugs. The effects of Prozac on “personality” were widely publicized and drug companies advertise indirectly and, more recently directly to the consumer, relegating physicians to the role of middleman. The patient now demands the prescription and the doctor complies. The consumer hopes that Prozac and related drugs can increase energy, confidence and assertiveness. “Shy” people were added to list of potential customers.
Although writers such as psychiatrist Peter Kramer (Listening to Prozac) suggested that the patient's interest in personality changing drugs was a new market force, nothing new really happened; it is the same old interest in psychotropic drugs but the names, the players and the prices changed. Cocaine outsells Prozac, but the profitability of prescription antidepressant drugs is outstanding.
Goodman, Chair of the US Food and Drug Administration (FDA) Psychopharmacologic Drugs Advisory Committee made a public statement in 2006 that claims in drug monographs and advertising that selective serotonin reuptake inhibitor (SSRI) antidepressants work by normalizing serotonin levels are not based on scientific evidence and should be prohibited. Moynihan and Cassels described the drug industry's marketing tactics. With obscene profits from drug sales; a drug company can afford to control the naming and perception of diseases by physicians, government, and consumers. They create drug demand by advertising to consumers and doctors at the same time. For example, Cohn & Wolfe Healthcare, SmithKline's PR firm created “social phobia disorder” treatable with Paxil, which became the world's best-selling antidepressant, earning US$3 billion annually.
Brain Drugs -- Benefit or Harm?
A review of data, just published, from the US Women's Health Initiative study (involving 136,293 postmenopausal women) revealed that , 5496 women taking drugs from the two major antidepressant groups, tricyclic antidepressants (TCI) and selective serotonin-reuptake inhibitors (SSRI), had increased all-cause mortality; SSRIs users had a 45% increased relative risk of incidence stroke and a 32% increased risk of death with a higher incidence of hemorrhagic strokes. The incidence of stroke per 1000 person-years with no antidepressant use was 2.99; the incidence for SSRI users was 4.16 for. Death rates for per 1000 person-years were 12.77 for SSRI users and 14.14 for TCI users, compared with 7.79 for non–antidepressant users. Studies of this nature cannot differentiate the negative effects of dugs from the underlying disease processes. In medical talk, depression has assumed a false reality, becoming a malevolent agent that acts upon its victim. While sad, tired and angry people are real, depression is not real and is not a cause of something else such as a stroke. My conclusion is that antidepressant drugs are potentially harmful and can add to the existing pathologies that they pretend to treat
Antidepressants are chemicals that are added to a dysfunctional chemical mix that caused dysfunction and dysphoria in the first place. Few patients make any effort to alter their disease-causing lifestyle and few physicians make any effort to investigate and improve the patient’s chemistry overall. Psychotropic drugs are added to the dysfunctional chemical mix and its effects merge with coffee, alcohol, the chemistry of food additives, and contaminants, sugars, food allergy and airborne neurotoxins that act on the brain.
New problems added by the prescription chemical may suddenly emerge such as unexpected bursts of anger and aggression or increased tendency to have violent suicidal thoughts. One young woman reported to me that after taking Prozac for two weeks, she had threatened her live-in boyfriend with hammer, chased him into the bathroom and attacked the closed door, smashing holes in the door until she more or less recovered composure. Her boyfriend fled the apartment and never returned. The boyfriend was domineering and verbally abusive, as boyfriends sometimes are, but the pre-Prozac young woman was usually compliant and never had a violent temper. Her Prozac rage is an example of chemically triggered behavior. Prozac may provoke agitated preoccupation with suicide or violence directed against others. The drug facilitates the rage response, as do most of the drugs that suppress appetite. Up to 73% of patients taking antidepressant report sexual dysfunction, such as diminished sexual desire, delayed sexual arousal, and muted or absent orgasm.
Fisher suggested that these drugs blunt emotions and interfere with forming and maintaining meaningful relationships. When men and women take serotonin-enhancing drugs and fail to achieve orgasm, an important feature of pair bonding fails. You would not be surprised to learn that a woman taking Prozac decided to divorce her husband, stating that she no longer loved him. After she stopped taking the drug, she loved him again and stayed married.
Prozac can facilitate the rage response and may lead to acts of aggression and violence that otherwise would not occur. Prozac also inhibits appetite for food and sexual appetites; sometime useful effects, but not always. In Canada, three similar antidepressants were among the top-selling drugs; these are Prozac, Paxil, and Zoloft. Lauren Slater called Prozac the "Big Mac of Medicine" because of its popularity and the faddish consumer appeal based on the futile hope that a drug could resolve human suffering. She described the dramatic and brief benefits of taking Prozac: "those first few mornings were fairy tales, tall tales, replete with all the bent beauty of a New World." Her story is not simple, however and the long-term effects of taking the drug are mixture of benefits and negative effects. The initial recovery from depression is not sustained and a three or four phase sequence can often be discerned, beginning with an initial improvement that occurs in the first 2 to 4 weeks. The statement “the first time was the best time" applies to most, if not to all psychotropic drugs.
In Slater's experience, Prozac removed her sexual drive, blunted her creativity and reduced her appetite. The underlying problems are many and begin with the lack of specificity of the drug. Prozac blocks Serotonin re-uptake and in stage 1 of its activity, probably increases serotonin receptor activity in all areas of the brain. Serotonin synapses are not all conveniently arranged just to alleviate depression and a whole complex of unrelated functions are affected. The brain is not passive and changes to offset or accommodate the drug activity; the effects then shift to an adapted state, different from the initial drug-dependent state. The person taking the drug has also shifted in terms of behavior and learning and may be learning new skills and, at the same time, coping with new problems such increased anger, loss of libido and blunted feelings.
Martin Enserink reviewed the development of antidepressant drugs and stated: ‘Antidepressants have evolved through several generations since the 1950s, each a “huge improvement” over its predecessor--or so advocates have claimed. But a government-sponsored study published last month confirmed what other analyses had shown before: The fashionable antidepressants of the 1990s are no more effective than those of previous generations. The study, a meta-analysis commissioned by the Agency for Health Care Policy and Research (a part of the Department of Health and Human Services, USA) and carried out by the Evidence Based Practice Center in San Antonio, Texas, looked at 315 studies carried out since 1980. It focused primarily on the hottest pills that have hit the market since 1987, the "selective serotonin reuptake inhibitors" (SSRIs), a group that includes such brands as Prozac, Paxil, and Zoloft. The study found that on average, about 50% of patients in SSRI treatment groups improved, compared to 32% in placebo groups. But in the more than 200 trials that compared new drugs with older ones, the two classes proved equally efficacious. Because the newer drugs appear to have less severe side effects, however, patients may be able to stay on them longer. The failure to find evidence of progress is disappointing, scientists admit. And one of the biggest disappointments is that researchers still don't understand what causes--or relieves--depression. Most antidepressant drugs are based on the assumption that depression results from a shortage of serotonin or norepinephrine in the brain. Both are neurotransmitters, chemical messengers that cross the synapse, the cleft between two nerve cells. The first generation of antidepressants, discovered during the early 1950s, the MAO inhibitors, block monoamine oxidase, an enzyme that breaks down serotonin and norepinephrine. This allows the neurotransmitters to linger in the synapse, increasing their effect. Another type of drug discovered in the late 1950s, the tricyclics, prevents the nerve cells that excrete the neurotransmitters from mopping up these compounds shortly after they are released. Blocking "reuptake" also prolongs their effect. Because studies pointed to serotonin shortage as the main culprit in depression, industry developed the selective reuptake inhibitors, which now dominate the market.”
Data from United Kingdom's General Practice Research Database of 6.4 million patients were used to discover a relationship between antidepressant use and diabetes 2: 165,958 patients were identified who received at least 1 new prescription for an antidepressant between January 1, 1990 and June 30, 2005. The researchers conclded that taking moderate to high daily doses of antidepressants for more than 2 years is associated with an 84% increased risk for diabetes.The increased risk was particularly notable for the selective serotonin reuptake inhibitor (SSRI) paroxetine and the tricyclic antidepressant amitriptyline. Another study, the Diabetes Prevention Program (DPP) trial found that antidepressant use over an average of 3.2 years was associated with an increased risk for diabetes of 2.60 in the placebo group and 3.39 in the lifestyle-intervention group, but there was no increased risk in the metformin group. Paroxetine caused a 4-fold increased risk for diabetes above 20 mg/day. Related drugs, fluoxetine, citalopram, or sertraline did not increase the risk.
From the book: The Human Brain in Health and Disease by Stephen Gislason MD
Saturday, November 28, 2009
Impermanence & Plasticity
Everything changes. The largest chunk of uncertainly is impermanence. There are constant paradoxes and contradictions built into our brain function. We must be alert to notice and respond to changes but, at the same time, attempt to be stable and consistent. Our visual system is designed to notice minute changes but ignores most of the movement around us to create the illusion of a stable world in consciousness. Growth, development, and aging are the main expressions of predetermined impermanence that combines DNA programming with environmental opportunities and hazards.
You could argue that brain growth and development changes are most vigorous in the first 20 years of life; later, after a brief period of relative stability, degenerative changes take over, accelerating with advancing age.
A big problem we have is that while the world around us changes, we also change and the biggest changes occur in our brain. The idea of one personality remaining stable over many years is actually absurd, but we are tempted to believe in an enduring self. An astute observer will notice that each day brings forward a series of different personalities within one body. I call these personalities eigenstates. The self is not one entity but rather consists of a collection eigenstates that serve different needs, roles and capabilities. Some eigenstates are built it others are learned and remain open-ended, evolving with changing circumstances.
Learning, in the best case, is adaptive impermanence that requires changes to brain structure and function. We will consider, for example, that learned movements are generated from dynamic cortical maps based on fields of activity that converge and diverge in complex patterns. Over time, the pieces of the map change with learning and practice, so that the construction of cortical connections is always in flux. This impermanence allows us to learn at all stages of life, to adjust to changing environments and, to some extent, to work around disabilities that arise from brain injury and disease.
Among affluent self-indulgent humans, there is conspicuous age denial and much promotion of anti-aging products and procedures. While, in the best case, humans can continue to learn into old age, the facts are not so encouraging. All brain functions decline with age and degenerative brain diseases appear with increasing frequency as the years advance. Slogans such as use it or lose it may contain some truth, but it is never obvious that high functioning elderly humans are doing well because of brain exercise with crossword puzzles rather than by luck, cleaner air, better DNA and superior diet. It is more obvious that sustained physical activity, reduced caloric intake and good nutrition are the keys to high functioning aging.
Too often, I am an unwilling victim of television news nonsense and plasticity is a current favorite topic. Brain damaged survivors are shown with plausible mental abilities, as if their example refuted neuroscience beliefs. The term plasticity has crept into neuroscience jargon and should be erased from the vocabulary. I am not aware of the source of plastic metaphor and can only assume that it refers to a material that can be coaxed into different shapes by heat and pressure using a variety of machines. I cannot see any connection between the malleability of plastic and the constant flux that characterize brain function.
Even smart, educated humans participate in these media delusions. For example, I was surprised to read a report by Allison Gandey from a meeting of the American Academy of Pain Medicine that revealed basic ignorance among a group of smart professionals. She stated: " Some suggest the discovery of neuroplasticity is the most important breakthrough in neuroscience since the revelation of the brain's basic anatomy. Proponents say the brain is pliable and can alter its structure and function. " One MD even admitted:" We used to think the brain was wired after about the first 3 years and what you had was what you got and you work within that because there was no chance of changing it. If on top of that the brain was damaged, you had to live with that damage. Neuroplasticity says that's not so — the brain is changing all the time."
It is true that the brain is changing all the time, but it is not true that this is a discovery or a breakthrough. It is also not true that lost function is easy to recover. While it might be true that limited recovery of function is possible after brain injury, it is more true that loss of function tends to be permanent after the initial recovery in the first few months. You might consider that some physicians are just like everyone else, entertaining erroneous assumptions and unrealistic fantasies, but then, I also read rather naive comments about plasticity in the neuroscience literature.
Let me restate what should be a basic premise of neuroscience: All learning is adaptive impermanence that requires changes to brain structure and function. Another premise is that if learned skills are not refreshed through practice, skilled performance deteriorates.
You can fantasize opportunities to intervene with new technologies in the future to compensate for lost brain function, but progress to date is minimal. While there are limited populations of stem cells in the brain, their proliferation presents a hazard (aka cancer)more than a solution for degenerative brain diseases.
There is a growing body of knowledge about the growth and development of the brain from conception through adolescence; one important feature of childhood and adolescence is the pruning of synaptic connections. To make real sense from the facts as we known them is that brain structure and function is in turbulent flux with abundant opportunities for things to go wrong for 20 years. In the best case, a confused, rebellious adolescent will become a responsible adult who is a little more stable for the next 20 years and then begins a descent into cognitive decline. To believe that the brain is a finished organ at any age is nonsense. At the same time, you need to know that neurons are long lived cells that can survive from their origins in the fetus through old age. The cell body of the neuron must endure for its synaptic connections to change. The most dynamic structures are spines on dendrites and the synapses themselves. Damaged axons can regenerate if the cell body is still alive.
One basic idea in neuroscience is that the old brain is preprogrammed with maximal automaticity and stability whereas the neocortex is built to be modified. Survival depends on the stability of neuronal circuits in the oldest part of the brain. The critical controllers of respiration and cardiac function must be reliable or you die. You might compare the neocortex with dynamic random access memory in a computer that is programmable, stores memory, and can be erased.
There are time critical episodes in early development that leave no opportunity for recovery if things go wrong. Knudsen stated:" during a critical period, a neuronal pathway awaits specific instructional information encoded by impulse activity to continue developing normally. This information causes the pathway to commit irreversibly to one of a number of possible patterns of connectivity. There are critical periods for the development of form vision and stereopsis and for the development of appropriate social responses to members of the same species. "
See Neuroscience Notes by Stephen Gislason MD
You could argue that brain growth and development changes are most vigorous in the first 20 years of life; later, after a brief period of relative stability, degenerative changes take over, accelerating with advancing age.
A big problem we have is that while the world around us changes, we also change and the biggest changes occur in our brain. The idea of one personality remaining stable over many years is actually absurd, but we are tempted to believe in an enduring self. An astute observer will notice that each day brings forward a series of different personalities within one body. I call these personalities eigenstates. The self is not one entity but rather consists of a collection eigenstates that serve different needs, roles and capabilities. Some eigenstates are built it others are learned and remain open-ended, evolving with changing circumstances.
Learning, in the best case, is adaptive impermanence that requires changes to brain structure and function. We will consider, for example, that learned movements are generated from dynamic cortical maps based on fields of activity that converge and diverge in complex patterns. Over time, the pieces of the map change with learning and practice, so that the construction of cortical connections is always in flux. This impermanence allows us to learn at all stages of life, to adjust to changing environments and, to some extent, to work around disabilities that arise from brain injury and disease.
Among affluent self-indulgent humans, there is conspicuous age denial and much promotion of anti-aging products and procedures. While, in the best case, humans can continue to learn into old age, the facts are not so encouraging. All brain functions decline with age and degenerative brain diseases appear with increasing frequency as the years advance. Slogans such as use it or lose it may contain some truth, but it is never obvious that high functioning elderly humans are doing well because of brain exercise with crossword puzzles rather than by luck, cleaner air, better DNA and superior diet. It is more obvious that sustained physical activity, reduced caloric intake and good nutrition are the keys to high functioning aging.
Too often, I am an unwilling victim of television news nonsense and plasticity is a current favorite topic. Brain damaged survivors are shown with plausible mental abilities, as if their example refuted neuroscience beliefs. The term plasticity has crept into neuroscience jargon and should be erased from the vocabulary. I am not aware of the source of plastic metaphor and can only assume that it refers to a material that can be coaxed into different shapes by heat and pressure using a variety of machines. I cannot see any connection between the malleability of plastic and the constant flux that characterize brain function.
Even smart, educated humans participate in these media delusions. For example, I was surprised to read a report by Allison Gandey from a meeting of the American Academy of Pain Medicine that revealed basic ignorance among a group of smart professionals. She stated: " Some suggest the discovery of neuroplasticity is the most important breakthrough in neuroscience since the revelation of the brain's basic anatomy. Proponents say the brain is pliable and can alter its structure and function. " One MD even admitted:" We used to think the brain was wired after about the first 3 years and what you had was what you got and you work within that because there was no chance of changing it. If on top of that the brain was damaged, you had to live with that damage. Neuroplasticity says that's not so — the brain is changing all the time."
It is true that the brain is changing all the time, but it is not true that this is a discovery or a breakthrough. It is also not true that lost function is easy to recover. While it might be true that limited recovery of function is possible after brain injury, it is more true that loss of function tends to be permanent after the initial recovery in the first few months. You might consider that some physicians are just like everyone else, entertaining erroneous assumptions and unrealistic fantasies, but then, I also read rather naive comments about plasticity in the neuroscience literature.
Let me restate what should be a basic premise of neuroscience: All learning is adaptive impermanence that requires changes to brain structure and function. Another premise is that if learned skills are not refreshed through practice, skilled performance deteriorates.
You can fantasize opportunities to intervene with new technologies in the future to compensate for lost brain function, but progress to date is minimal. While there are limited populations of stem cells in the brain, their proliferation presents a hazard (aka cancer)more than a solution for degenerative brain diseases.
There is a growing body of knowledge about the growth and development of the brain from conception through adolescence; one important feature of childhood and adolescence is the pruning of synaptic connections. To make real sense from the facts as we known them is that brain structure and function is in turbulent flux with abundant opportunities for things to go wrong for 20 years. In the best case, a confused, rebellious adolescent will become a responsible adult who is a little more stable for the next 20 years and then begins a descent into cognitive decline. To believe that the brain is a finished organ at any age is nonsense. At the same time, you need to know that neurons are long lived cells that can survive from their origins in the fetus through old age. The cell body of the neuron must endure for its synaptic connections to change. The most dynamic structures are spines on dendrites and the synapses themselves. Damaged axons can regenerate if the cell body is still alive.
One basic idea in neuroscience is that the old brain is preprogrammed with maximal automaticity and stability whereas the neocortex is built to be modified. Survival depends on the stability of neuronal circuits in the oldest part of the brain. The critical controllers of respiration and cardiac function must be reliable or you die. You might compare the neocortex with dynamic random access memory in a computer that is programmable, stores memory, and can be erased.
There are time critical episodes in early development that leave no opportunity for recovery if things go wrong. Knudsen stated:" during a critical period, a neuronal pathway awaits specific instructional information encoded by impulse activity to continue developing normally. This information causes the pathway to commit irreversibly to one of a number of possible patterns of connectivity. There are critical periods for the development of form vision and stereopsis and for the development of appropriate social responses to members of the same species. "
See Neuroscience Notes by Stephen Gislason MD
Wednesday, September 23, 2009
Naproxen Wins the Best NSAID Award.
I have followed the saga of nonsteroidal anti-inflammatory agents (NSAIDs) since Vioxx was withdrawn from the market in 2004. Rather intense reviews of NSAIDs followed with uncertainty about which drugs were the safest to use. As of Sept.2009, the winner is Naproxen, in doses less than 1000 mg per day.
A large retrospective study examined the medical records of 48,566 adults between the ages of 40 and 89 years who were admitted to hospital with coronary artery disease. The databases used came from Canada, the United States, and the United Kingdom. The study found that naproxen was not associated with a higher risk for coronary heart disease events or cardiac death in patients with a history of coronary heart disease. However, ibuprofen; high-dose celecoxib; high-dose rofecoxib; and, diclofenac, did increase this risk.
Relative to naproxen, current users of diclofenac had increased risk of serious coronary heart disease x 1.44 and serious cardiovascular disease/death x 1.52; ibuprofen had increased risk x 1.25; coronary heart disease risk increased for rofecoxib >25 mg x 2.29; celecoxib >200 mg x 1.61.
Recall that in September 2004, Merck & Co announced a voluntary withdrawal of Vioxx from the U.S. and worldwide market due to safety concerns of an increased risk of heart attacks and strokes, according to an alert from MedWatch, the U.S. Food and Drug Administration (FDA) safety information and adverse event reporting program. Vioxx was one of several selective COX-2 inhibitors that were marketed aggressively as the best drugs for pain relief. Because they were prescription drugs and more expensive, patients believed they were better than ASA, ibuprofen, diclofenac or naproxen but this was not true.
The claimed advantage of the COX-2 inhibitors, slightly lower incidence of gastrointestinal bleeding was supported by some but not all studies Cox-2 inhibitors that offered no advantage in terms of pain relief and anti-inflammatory effects. The fate of COX-2 inhibitors has been dismal. A growing controversy surrounded the use of Cox-2 inhibitors since their introduction in 1999. The drug companies involved were competing to secure a large share of the multi-billion-dollar-a-year market for pain-relieving anti-inflammatory drugs. A news report in 2002, for example, warned people that: "Elderly patients taking Vioxx, the most popular arthritis drug in Canada, were twice as likely to be hospitalized with major gastrointestinal bleeding than those taking its pharmaceutical competitor, Celebrex. In 2002, 3.4 million prescriptions for Vioxx were filled across Canada; 3.1 million for Celebrex.
The Therapeutics Initiative Newsletter in BC issued the following COX-2 inhibitors update in 2002: “Based on FDA data from the CLASS and VIGOR studies, COX-2 selective inhibitors are associated with an increased incidence of serious adverse events as compared to non-selective NSAIDs."
Reference: Ray WA, Varas-Lorenzo C, Chung CP, et al. Cardiovascular risks of nonsteroidal antiinflammatory drugs in patients after hospitalization for serious coronary heart disease. Circ Cardiovasc Qual Outcomes 2009; 2:155-163.
From the 2009 book, Heart and Arteries by Stephen Gislason MD
A large retrospective study examined the medical records of 48,566 adults between the ages of 40 and 89 years who were admitted to hospital with coronary artery disease. The databases used came from Canada, the United States, and the United Kingdom. The study found that naproxen was not associated with a higher risk for coronary heart disease events or cardiac death in patients with a history of coronary heart disease. However, ibuprofen; high-dose celecoxib; high-dose rofecoxib; and, diclofenac, did increase this risk.
Relative to naproxen, current users of diclofenac had increased risk of serious coronary heart disease x 1.44 and serious cardiovascular disease/death x 1.52; ibuprofen had increased risk x 1.25; coronary heart disease risk increased for rofecoxib >25 mg x 2.29; celecoxib >200 mg x 1.61.
Recall that in September 2004, Merck & Co announced a voluntary withdrawal of Vioxx from the U.S. and worldwide market due to safety concerns of an increased risk of heart attacks and strokes, according to an alert from MedWatch, the U.S. Food and Drug Administration (FDA) safety information and adverse event reporting program. Vioxx was one of several selective COX-2 inhibitors that were marketed aggressively as the best drugs for pain relief. Because they were prescription drugs and more expensive, patients believed they were better than ASA, ibuprofen, diclofenac or naproxen but this was not true.
The claimed advantage of the COX-2 inhibitors, slightly lower incidence of gastrointestinal bleeding was supported by some but not all studies Cox-2 inhibitors that offered no advantage in terms of pain relief and anti-inflammatory effects. The fate of COX-2 inhibitors has been dismal. A growing controversy surrounded the use of Cox-2 inhibitors since their introduction in 1999. The drug companies involved were competing to secure a large share of the multi-billion-dollar-a-year market for pain-relieving anti-inflammatory drugs. A news report in 2002, for example, warned people that: "Elderly patients taking Vioxx, the most popular arthritis drug in Canada, were twice as likely to be hospitalized with major gastrointestinal bleeding than those taking its pharmaceutical competitor, Celebrex. In 2002, 3.4 million prescriptions for Vioxx were filled across Canada; 3.1 million for Celebrex.
The Therapeutics Initiative Newsletter in BC issued the following COX-2 inhibitors update in 2002: “Based on FDA data from the CLASS and VIGOR studies, COX-2 selective inhibitors are associated with an increased incidence of serious adverse events as compared to non-selective NSAIDs."
Reference: Ray WA, Varas-Lorenzo C, Chung CP, et al. Cardiovascular risks of nonsteroidal antiinflammatory drugs in patients after hospitalization for serious coronary heart disease. Circ Cardiovasc Qual Outcomes 2009; 2:155-163.
From the 2009 book, Heart and Arteries by Stephen Gislason MD
Wednesday, July 29, 2009
Mental Illness
When someone's brain is not working properly others describe them as "mentally ill." Mental health and mental illness are poorly chosen terms that obscure the medical and social issues that arise whenever human dysfunction is examined. The hospital in my community has a separate building described on a sign as “Mental Health and Addiction Services.” I suspect that the staff and the patients that use this building do not understand what “mental health” means. I am certain that the juxtaposition of the words “health” and “addiction” is a mistake.
Kurt Vonnegut described the cause of mental illness as “bad chemicals.” Humans are unrealistic about what substances they can safely ingest, inhale and inject into their bodies. Humans are most unrealistic about how easily and how profoundly small amounts of external chemicals can affect their mind. They believe that they are tougher than they are. Modern psychiatric theory imagines bad chemicals or good chemicals in the wrong amounts manufactured by mistake inside the brain of each victim. Physicians often view the brain as a black box with no chemical input except the drugs they prescribe. A neurobiologist will recognize that numerous chemicals arrive from the outside to interact with brain chemistry. Bad chemicals in the food supply can disturb brain function in entire populations with endemic brain dysfunction as the result.
The World Health Organization claimed that one-fourth of the world’s population is affected at any time by depression, other mental disorders or substance abuse problems. According to the WHO report: "Women are more often affected then men. The higher prevalence of mood disorders in women may include the frustration of relying on the role of housewife for identity and self-esteem; lack of personal income; and for those who do work lower pay and more labor-intensive jobs than men." In addition, violence against women has been recognized as a growing problem. Some studies show that as many as half of all women living on planet earth have been physically abused at some time in their lives. Their abusers are mostly men and most of those men are boy friends, spouses, family members or close “friends.”
Kessel et al suggested that half of all Americans will have a mental illness during their lifetime, with symptoms beginning in the teen years for many. They favored diagnoses such as mood disorders, anxiety, impulse control and substance disorders. Rather than using fuzzy terms such as “anxiety, mood disorders or depression,” we can recognize “mental illness” as a variety of interacting maladaptations caused by bad genes, bad chemicals, bad food, infections, malnutrition, poverty, oppression and abuse.
Mental disturbances are the first symptoms of bad environments that substitute disease-causing conditions for healthy conditions.
Mental illness is often self-inflicted by overeating the wrong foods, drinking alcohol to excess, using and abusing drugs obtained from both legal and illegal sources.
Social Chaos
Common effects of erratic brain function are conflict and chaos. Two people living together with erratic brain function increase chaos by more than a factor of two. More people interacting erratically increase chaos exponentially until family structures, community structures, and national structures become dysfunctional.
Bad chemicals entering human brains from polluted air and water, wrong foods, alcoholic beverages, legal and illegal drugs is a recipe for a society's dysphoric disintegration. We might better appreciate the folly of "fighting a drug war" when we realize that most chemical demons live at home. Unfortunately, in terms of substances that can impair brain function, “drug sellers" include every corner store, fast food outlet, pop vendor, pharmacy and supermarket. Local bars and liquor outlets generate a continuous stream of social and health problems at an enormous cost to society.
We must be smart enough to see the connections among food materials which influence brain function: alcoholic beverages, nicotine in tobacco, teas, coffee, chocolate, spices, food additives, sugar excess, wheat, milk, eggs, prescription drugs and street drugs. We should be very concerned about the prescription drug problem with drug addiction and dependency that is supported by all our institutions. Unfortunately, the practice of medicine has become a drug-pushing affair. An addicted society will better tolerate the social pathology and diseases caused by tobacco smoke, alcoholic beverages, air pollution, bad food, sedatives, antidepressants, tranquilizers, and sleeping pills but displaces its dysphoric energy in a "drug war" against cocaine, heroin and a few other "drugs of abuse".
Humans are seldom consistent in setting goals and priorities so that societal confusion about the use and abuse of food chemicals and drugs is more or less predictable. Smart policy makers will, however, understand that most citizens are under the influence of one mid-altering drug or another. The daily use and abuse of several brain chemicals produces mentally disabled people who are neither reasonable nor correct in their thinking and conduct. When physicians intervene and prescribe more chemicals, they add to the chaotic mix, not realizing there is there is little hope of benefit. To my way of thinking, this “drug psychotherapy” has become a perverse enterprise with no happy endings in sight.
Read the Human Brain in Health and Disease by Stephen Gislason MD
Kurt Vonnegut described the cause of mental illness as “bad chemicals.” Humans are unrealistic about what substances they can safely ingest, inhale and inject into their bodies. Humans are most unrealistic about how easily and how profoundly small amounts of external chemicals can affect their mind. They believe that they are tougher than they are. Modern psychiatric theory imagines bad chemicals or good chemicals in the wrong amounts manufactured by mistake inside the brain of each victim. Physicians often view the brain as a black box with no chemical input except the drugs they prescribe. A neurobiologist will recognize that numerous chemicals arrive from the outside to interact with brain chemistry. Bad chemicals in the food supply can disturb brain function in entire populations with endemic brain dysfunction as the result.
The World Health Organization claimed that one-fourth of the world’s population is affected at any time by depression, other mental disorders or substance abuse problems. According to the WHO report: "Women are more often affected then men. The higher prevalence of mood disorders in women may include the frustration of relying on the role of housewife for identity and self-esteem; lack of personal income; and for those who do work lower pay and more labor-intensive jobs than men." In addition, violence against women has been recognized as a growing problem. Some studies show that as many as half of all women living on planet earth have been physically abused at some time in their lives. Their abusers are mostly men and most of those men are boy friends, spouses, family members or close “friends.”
Kessel et al suggested that half of all Americans will have a mental illness during their lifetime, with symptoms beginning in the teen years for many. They favored diagnoses such as mood disorders, anxiety, impulse control and substance disorders. Rather than using fuzzy terms such as “anxiety, mood disorders or depression,” we can recognize “mental illness” as a variety of interacting maladaptations caused by bad genes, bad chemicals, bad food, infections, malnutrition, poverty, oppression and abuse.
Mental disturbances are the first symptoms of bad environments that substitute disease-causing conditions for healthy conditions.
Mental illness is often self-inflicted by overeating the wrong foods, drinking alcohol to excess, using and abusing drugs obtained from both legal and illegal sources.
Social Chaos
Common effects of erratic brain function are conflict and chaos. Two people living together with erratic brain function increase chaos by more than a factor of two. More people interacting erratically increase chaos exponentially until family structures, community structures, and national structures become dysfunctional.
Bad chemicals entering human brains from polluted air and water, wrong foods, alcoholic beverages, legal and illegal drugs is a recipe for a society's dysphoric disintegration. We might better appreciate the folly of "fighting a drug war" when we realize that most chemical demons live at home. Unfortunately, in terms of substances that can impair brain function, “drug sellers" include every corner store, fast food outlet, pop vendor, pharmacy and supermarket. Local bars and liquor outlets generate a continuous stream of social and health problems at an enormous cost to society.
We must be smart enough to see the connections among food materials which influence brain function: alcoholic beverages, nicotine in tobacco, teas, coffee, chocolate, spices, food additives, sugar excess, wheat, milk, eggs, prescription drugs and street drugs. We should be very concerned about the prescription drug problem with drug addiction and dependency that is supported by all our institutions. Unfortunately, the practice of medicine has become a drug-pushing affair. An addicted society will better tolerate the social pathology and diseases caused by tobacco smoke, alcoholic beverages, air pollution, bad food, sedatives, antidepressants, tranquilizers, and sleeping pills but displaces its dysphoric energy in a "drug war" against cocaine, heroin and a few other "drugs of abuse".
Humans are seldom consistent in setting goals and priorities so that societal confusion about the use and abuse of food chemicals and drugs is more or less predictable. Smart policy makers will, however, understand that most citizens are under the influence of one mid-altering drug or another. The daily use and abuse of several brain chemicals produces mentally disabled people who are neither reasonable nor correct in their thinking and conduct. When physicians intervene and prescribe more chemicals, they add to the chaotic mix, not realizing there is there is little hope of benefit. To my way of thinking, this “drug psychotherapy” has become a perverse enterprise with no happy endings in sight.
Read the Human Brain in Health and Disease by Stephen Gislason MD
Tuesday, July 21, 2009
Pandemic Viral Illnesses Occur Every Year.
A Perspective
What interests me and other science philosophers is how nonsense routinely overwhelms reliable knowledge. Humans appear to have an endless capacity and need to generate nonsense. Nonsense is generated, in part, as nominal fog that obscures a simple truth - we do not know what will happen next. "Experts" are just as limited as the most ignorant and opinionated nonsense generator. You could, without any hesitation, award television news media with the Oscar for the best nonsense generators of the year. Their nonsense spreads worldwide with speed and penetration that would make any virulent virus envious.
There are a host of current examples of noumenal fog generators under titles such as Health Care, Economy, National Security, Terrorism and most recently, Pandemic. Whenever these key words appear, have a look, you will not be disappointed -- the ratio of nonsense to sense will be at least 9 to 1.
I have chosen today to do a brief review of the Swine Flu Scare of 2009 - a great pile of nonsense that seem to have overwhelmed even the most cautious of scientists. This is not to argue that H1A1 viruses are innocuous, but to develop a perspective on the relative threats of viruses in general and to reveal that the evidence for swine flu as a special threat is lacking.
In the Northern hemisphere, viral epidemics cause up to 80% of all respiratory illnesses. The most common infections are caused by six viral groups: rhinovirus (RVs), respiratory syncytial virus, influenza virus, parainfluenza virus, corona virus, and adenovirus. In one study of 285 children admitted to hospital with lung infection, viruses were identified in 125 - respiratory syncytial virus (107), influenza (9) and parainfluenza type 3 (9). Clinical and radiologic diagnoses included bronchiolitis (127), interstitial pneumonia (47) and lobar pneumonia (91).
Rhinoviruses often referred to as “cold viruses” cause the majority of respiratory illnesses. Other viruses contribute to waves of colds, coughs, bronchitis, asthma and pneumonia that pass through every human population in epidemic patterns. Colds are rhinovirus infections that are usually mild and self-limiting but are more serious in premature babies and children with chronic diseases or immunosuppression. The average child can expect to have four to eight rhinovirus infections per year, and adults have three to five infections.
Respiratory Syncytial Virus is spread by coughing and sneezing; by close contact with sick patients or by hand contamination. Infection develops in care -givers who touch their eyes or nose with contaminated fingers.
Adenoviruses While Influenza viruses are well-known and epidemics of more virulent influenza strains are feared, other less known viruses, especially adenoviruses, tend to be common and can produce severe illnesses. For example, adenoviruses are the second most prevalent cause of acute lower respiratory infection of viral origin in children under four years of age in Buenos Aires, Argentina. Pneumonia was observed in 71% and bronchiolitis in 29% of children admitted to hospital with adenovirus infection. Wheezing occurred in 58% of the children. Four children died (a fatality rate of 16.7%). Adenoviruses have emerged as important pathogens in immunocompromised patients, in whom disseminated disease occurs frequently and is associated with a high mortality rate. For over 25 years, the US military controlled adenoviral respiratory infections through immunization of its members. A group of Navy physicians reported a “large epidemic of respiratory illness due to adenovirus in healthy young adults” after adenovirus vaccine supplies were depleted.
The US military medical services are perhaps best equipped to diagnose and treat adenovirus infection which cause outbreaks of disease among military recruits. A National Surveillance for Emerging Adenovirus Infections system includes military and civilian laboratories at 15 sites in the USA. Fifty-one adenovirus serotypes have been identified. In 2007 the emergence of a virulent Ad14 variant spread through the United States with some deaths. Ad14 infection was described initially in 1955 and was responsible for an epidemic acute respiratory disease in military recruits in Europe in 1969. In 2001-2002, Ad14 was associated with approximately 8% of respiratory adenoviral infections in the pediatric ward of a Taiwan hospital, with approximately 40% of Ad14 cases in children aged 4-8 years manifesting as lower airway disease. During the years, 2004-2007, the US surveillance system detected 17 isolates of Ad14 from seven sites. During March-June 2007, a total of 140 additional cases of confirmed Ad14 respiratory illness were identified in Oregon, Washington, and Texas. Fifty-three (38%) of these patients were hospitalized, including 24 (17%) who were admitted to intensive care units (ICUs); nine (5%) patients died
Influenza viruses cause epidemic respiratory illness every winter in most countries on the planet. New virus strains spread globally and cause prolonged illness and some deaths. The routine death toll in the US and Canada every year has been estimated to be 32,000 people.
Since the exact cause of fatal pneumonia is seldom correctly diagnosed, the fatality rate for influenza ( and other viral infections) is not really known. Other viruses also cause illnesses that spread globally with substantial morbidity, cost and some deaths. Influenza often begins with cold symptoms and progresses to involve the lungs. Most patients develop a chronic cough that can last for weeks. Pneumonia can develop and is a common cause of death.
Much publicity has been given to the possibility of an especially virulent strain emerging that will increase the death toll from thousands per year in the US and Canada to millions. Some virologists were concerned that influenza virus epidemics in birds would produce a newly virulent human virus. The World Health Organization warned that the world was not prepared for the next pandemic ( true). As of January 2006, the strain of avian influenza, A (H5N1), has been identified in only 148 human, 79 of them fatal, from direct contact with infected birds. The strain was first detected in Hong Kong in 1997 and has spread through Southeast Asia and then in Russia and Turkey. So far, bird flu has not become a major threat to human survival.
In 2009 a H1N1 variant ("swine flu") emerged and caused another media frenzy; the WHO declared a "pandemic" and despite reports of a relatively mild illness with a low mortality rate, news anchors began to refer to a "deadly virus" (false). The positive aspect of the scare tactics was increased international cooperation in monitoring the spread of the virus and increased funding of vaccine development.
Some of the fear was generated by comparison with the 1917 flu pandemic caused by another H1A1 virus. The truth is that speculations adn predictions based on very limited knowledge of that pandemic are likely to be wrong. While you can argue that every year, influenza and many other types of viruses create pandemics and every year more virulent strains could emerge, there is no reliable knowledge that allows experts to predict what will happen next.
Airborne causes of illness are discussed in the 2009 book,
Air and Breathing by Stephen Gislason MD
What interests me and other science philosophers is how nonsense routinely overwhelms reliable knowledge. Humans appear to have an endless capacity and need to generate nonsense. Nonsense is generated, in part, as nominal fog that obscures a simple truth - we do not know what will happen next. "Experts" are just as limited as the most ignorant and opinionated nonsense generator. You could, without any hesitation, award television news media with the Oscar for the best nonsense generators of the year. Their nonsense spreads worldwide with speed and penetration that would make any virulent virus envious.
There are a host of current examples of noumenal fog generators under titles such as Health Care, Economy, National Security, Terrorism and most recently, Pandemic. Whenever these key words appear, have a look, you will not be disappointed -- the ratio of nonsense to sense will be at least 9 to 1.
I have chosen today to do a brief review of the Swine Flu Scare of 2009 - a great pile of nonsense that seem to have overwhelmed even the most cautious of scientists. This is not to argue that H1A1 viruses are innocuous, but to develop a perspective on the relative threats of viruses in general and to reveal that the evidence for swine flu as a special threat is lacking.
In the Northern hemisphere, viral epidemics cause up to 80% of all respiratory illnesses. The most common infections are caused by six viral groups: rhinovirus (RVs), respiratory syncytial virus, influenza virus, parainfluenza virus, corona virus, and adenovirus. In one study of 285 children admitted to hospital with lung infection, viruses were identified in 125 - respiratory syncytial virus (107), influenza (9) and parainfluenza type 3 (9). Clinical and radiologic diagnoses included bronchiolitis (127), interstitial pneumonia (47) and lobar pneumonia (91).
Rhinoviruses often referred to as “cold viruses” cause the majority of respiratory illnesses. Other viruses contribute to waves of colds, coughs, bronchitis, asthma and pneumonia that pass through every human population in epidemic patterns. Colds are rhinovirus infections that are usually mild and self-limiting but are more serious in premature babies and children with chronic diseases or immunosuppression. The average child can expect to have four to eight rhinovirus infections per year, and adults have three to five infections.
Respiratory Syncytial Virus is spread by coughing and sneezing; by close contact with sick patients or by hand contamination. Infection develops in care -givers who touch their eyes or nose with contaminated fingers.
Adenoviruses While Influenza viruses are well-known and epidemics of more virulent influenza strains are feared, other less known viruses, especially adenoviruses, tend to be common and can produce severe illnesses. For example, adenoviruses are the second most prevalent cause of acute lower respiratory infection of viral origin in children under four years of age in Buenos Aires, Argentina. Pneumonia was observed in 71% and bronchiolitis in 29% of children admitted to hospital with adenovirus infection. Wheezing occurred in 58% of the children. Four children died (a fatality rate of 16.7%). Adenoviruses have emerged as important pathogens in immunocompromised patients, in whom disseminated disease occurs frequently and is associated with a high mortality rate. For over 25 years, the US military controlled adenoviral respiratory infections through immunization of its members. A group of Navy physicians reported a “large epidemic of respiratory illness due to adenovirus in healthy young adults” after adenovirus vaccine supplies were depleted.
The US military medical services are perhaps best equipped to diagnose and treat adenovirus infection which cause outbreaks of disease among military recruits. A National Surveillance for Emerging Adenovirus Infections system includes military and civilian laboratories at 15 sites in the USA. Fifty-one adenovirus serotypes have been identified. In 2007 the emergence of a virulent Ad14 variant spread through the United States with some deaths. Ad14 infection was described initially in 1955 and was responsible for an epidemic acute respiratory disease in military recruits in Europe in 1969. In 2001-2002, Ad14 was associated with approximately 8% of respiratory adenoviral infections in the pediatric ward of a Taiwan hospital, with approximately 40% of Ad14 cases in children aged 4-8 years manifesting as lower airway disease. During the years, 2004-2007, the US surveillance system detected 17 isolates of Ad14 from seven sites. During March-June 2007, a total of 140 additional cases of confirmed Ad14 respiratory illness were identified in Oregon, Washington, and Texas. Fifty-three (38%) of these patients were hospitalized, including 24 (17%) who were admitted to intensive care units (ICUs); nine (5%) patients died
Influenza viruses cause epidemic respiratory illness every winter in most countries on the planet. New virus strains spread globally and cause prolonged illness and some deaths. The routine death toll in the US and Canada every year has been estimated to be 32,000 people.
Since the exact cause of fatal pneumonia is seldom correctly diagnosed, the fatality rate for influenza ( and other viral infections) is not really known. Other viruses also cause illnesses that spread globally with substantial morbidity, cost and some deaths. Influenza often begins with cold symptoms and progresses to involve the lungs. Most patients develop a chronic cough that can last for weeks. Pneumonia can develop and is a common cause of death.
Much publicity has been given to the possibility of an especially virulent strain emerging that will increase the death toll from thousands per year in the US and Canada to millions. Some virologists were concerned that influenza virus epidemics in birds would produce a newly virulent human virus. The World Health Organization warned that the world was not prepared for the next pandemic ( true). As of January 2006, the strain of avian influenza, A (H5N1), has been identified in only 148 human, 79 of them fatal, from direct contact with infected birds. The strain was first detected in Hong Kong in 1997 and has spread through Southeast Asia and then in Russia and Turkey. So far, bird flu has not become a major threat to human survival.
In 2009 a H1N1 variant ("swine flu") emerged and caused another media frenzy; the WHO declared a "pandemic" and despite reports of a relatively mild illness with a low mortality rate, news anchors began to refer to a "deadly virus" (false). The positive aspect of the scare tactics was increased international cooperation in monitoring the spread of the virus and increased funding of vaccine development.
Some of the fear was generated by comparison with the 1917 flu pandemic caused by another H1A1 virus. The truth is that speculations adn predictions based on very limited knowledge of that pandemic are likely to be wrong. While you can argue that every year, influenza and many other types of viruses create pandemics and every year more virulent strains could emerge, there is no reliable knowledge that allows experts to predict what will happen next.
Airborne causes of illness are discussed in the 2009 book,
Air and Breathing by Stephen Gislason MD
Monday, May 11, 2009
Who knows how to treat high blood pressure
We might wish that all the effort in hypertension research over several decades had determined an optimal approach for the treatment of hypertension. Instead, the proliferation of often-conflicting study results creates confusion and less certainly about an optimal approach. A public health approach would change the nation's diet, encourage exercise and launch a vigorous assault against obesity. Diet changes require less sodium, less sugar, less fat, more fruits and vegetables. Taking drugs is more popular since it requires no effort and no change in habits.
MDs are willing to prescribe several drugs to achieve “normal” blood pressure. In contrast, the US, the National Heart, Lung and Blood Institute the sponsor of the ALLHAT study, launched a High Blood Pressure Education Program in 2006. They hoped to encourage patients to adopt healthier lifestyles and to influence physicians’ drug prescribing habits. They stated that the basis for the program is the ALLHAT conclusion that " diuretics are more beneficial than calcium channel blockers (CCBs), angiotensin converting enzyme (ACE) inhibitors, or alpha-blockers as initial treatment to lower blood pressure and to protect against adverse effects of high blood pressure."
American Society of Hypertension issued Diabetes Guidelines 2008
ASH called for patient-centered management and early, aggressive treatment of hypertension in diabetics. Their advice might apply to everyone. The ASH urged physicians to adopt a more integrated, individualized approach to treating hypertension by treating the intricacies of each patient rather than focusing on the disease in isolation. Goal blood pressure in hypertensive diabetic patients remained 130/80 mm Hg. All patients should reduce weight reduction, improve diet, increase physical activity, limit alcohol consumption, never smoke and limit salt intake to less than 2.4 g/day. The report stressed a reduction to glycated hemoglobin [HbA1c] to less than 7% mantaining finger test fasting glucose levels in the range of 70-130 mg/d. Low-dose ASA (aspirin) 80 mg/day was recommended. Lipid leves in the blood should be: low-density lipoprotein cholesterol <> 40 mg/dL in men and > 45 mg/dL in women. Potassium levels should be kept to < 5 mEq/L.
2009 Update
In a best evidence review Vega stated:”Angiotensin-converting enzyme (ACE) inhibitors are some of the most commonly prescribed medications for hypertension. This enthusiasm for ACE inhibitors is somewhat inconsistent with current recommendations, which prefer thiazide diuretics as first-line medication for uncomplicated cases of hypertension. With the popularity of ACE inhibitors in mind, investigators conducted a systematic review of published studies to determine how effective the drugs actually are in reducing blood pressure.”
The conclusions: ACE inhibitors (benazepril, moexipril, ramipril captopril) were associated with an average reduction in systolic blood pressure between 6 mm Hg and 9 mm Hg and in diastolic blood pressure of 4-5 mm Hg; all drugs in this class are similar and achieved most of their power in reducing blood pressure at half of the maximum recommended dose, or less. Related drugs, angiotensin receptor blockers (ARB), provide similar modest reductions in blood pressure; 46 randomized controlled trials examining 9 ARBs, and found that average reductions in systolic and diastolic blood pressure were 8 mm Hg and-5 mm Hg, similar to ACE inhibitors. ARBs were effective at one eighth to one half of the manufacturers' recommended doses.There is no strong evidence that ACE inhibitors can prevent diabetes or heart failure.
An analysis of the Treating to New Targets (TNT) study was presented at the American Society of Hypertension 2009 Scientific Meeting. Messerli et al published did an analysis of the INVEST study, a trial comparing two antihypertensive regimens in 22 576 patients with hypertension and coronary artery disease, and found that excessively lowering diastolic blood pressure was harmful. Messerli stated: "It stands to reason that when you lower blood pressure too much, you can do harm. After all, if blood pressure is zero, mortality is 100%. So somewhere there must be a nadir, below which the lowering of blood pressure becomes counterproductive."
Compared with the reference blood pressures -- systolic >130 to 140 mm Hg and diastolic >70 to 80 mm Hg -- patients with systolic blood pressure <110 mm Hg had a threefold increased risk of cardiovascular events, whereas those with diastolic blood pressure <60 mm Hg had a 3.3-fold increased risk of events. Messerli suggested that lowest point of inflection on the morbidity and mortality curves was 140.6 mm Hg for systolic blood pressure and 79.8 mm Hg for diastolic blood pressure.
References
Bakris GL, Sowers JR; on behalf of the American Society of Hypertension Writing Group. ASH Position Paper: Treatment of hypertension in patients with diabetes -- an update. J Clin Hypertens (Greenwich). 2008;10:707-713.
Charles P. Vega .How Effective Are ACE Inhibitors for Hypertension? A Best Evidence Review. Posted Medscape Online 03/13/2009
Heran BS, Wong MM, Heran IK, Wright JM. Blood pressure lowering efficacy of angiotensin converting enzyme (ACE) inhibitors for primary hypertension. Cochrane Database Syst Rev. 2008;(4):CD003823.
Bangalore S, Messerli FH, Wun CC, et al. J-curve revisited: An analysis of blood pressure and cardiovascular events in the Treating to New Targets (TNT) trial. American Society of Hypertension; May 7, 2009; San Francisco, CA.
MDs are willing to prescribe several drugs to achieve “normal” blood pressure. In contrast, the US, the National Heart, Lung and Blood Institute the sponsor of the ALLHAT study, launched a High Blood Pressure Education Program in 2006. They hoped to encourage patients to adopt healthier lifestyles and to influence physicians’ drug prescribing habits. They stated that the basis for the program is the ALLHAT conclusion that " diuretics are more beneficial than calcium channel blockers (CCBs), angiotensin converting enzyme (ACE) inhibitors, or alpha-blockers as initial treatment to lower blood pressure and to protect against adverse effects of high blood pressure."
American Society of Hypertension issued Diabetes Guidelines 2008
ASH called for patient-centered management and early, aggressive treatment of hypertension in diabetics. Their advice might apply to everyone. The ASH urged physicians to adopt a more integrated, individualized approach to treating hypertension by treating the intricacies of each patient rather than focusing on the disease in isolation. Goal blood pressure in hypertensive diabetic patients remained 130/80 mm Hg. All patients should reduce weight reduction, improve diet, increase physical activity, limit alcohol consumption, never smoke and limit salt intake to less than 2.4 g/day. The report stressed a reduction to glycated hemoglobin [HbA1c] to less than 7% mantaining finger test fasting glucose levels in the range of 70-130 mg/d. Low-dose ASA (aspirin) 80 mg/day was recommended. Lipid leves in the blood should be: low-density lipoprotein cholesterol <> 40 mg/dL in men and > 45 mg/dL in women. Potassium levels should be kept to < 5 mEq/L.
2009 Update
In a best evidence review Vega stated:”Angiotensin-converting enzyme (ACE) inhibitors are some of the most commonly prescribed medications for hypertension. This enthusiasm for ACE inhibitors is somewhat inconsistent with current recommendations, which prefer thiazide diuretics as first-line medication for uncomplicated cases of hypertension. With the popularity of ACE inhibitors in mind, investigators conducted a systematic review of published studies to determine how effective the drugs actually are in reducing blood pressure.”
The conclusions: ACE inhibitors (benazepril, moexipril, ramipril captopril) were associated with an average reduction in systolic blood pressure between 6 mm Hg and 9 mm Hg and in diastolic blood pressure of 4-5 mm Hg; all drugs in this class are similar and achieved most of their power in reducing blood pressure at half of the maximum recommended dose, or less. Related drugs, angiotensin receptor blockers (ARB), provide similar modest reductions in blood pressure; 46 randomized controlled trials examining 9 ARBs, and found that average reductions in systolic and diastolic blood pressure were 8 mm Hg and-5 mm Hg, similar to ACE inhibitors. ARBs were effective at one eighth to one half of the manufacturers' recommended doses.There is no strong evidence that ACE inhibitors can prevent diabetes or heart failure.
An analysis of the Treating to New Targets (TNT) study was presented at the American Society of Hypertension 2009 Scientific Meeting. Messerli et al published did an analysis of the INVEST study, a trial comparing two antihypertensive regimens in 22 576 patients with hypertension and coronary artery disease, and found that excessively lowering diastolic blood pressure was harmful. Messerli stated: "It stands to reason that when you lower blood pressure too much, you can do harm. After all, if blood pressure is zero, mortality is 100%. So somewhere there must be a nadir, below which the lowering of blood pressure becomes counterproductive."
Compared with the reference blood pressures -- systolic >130 to 140 mm Hg and diastolic >70 to 80 mm Hg -- patients with systolic blood pressure <110 mm Hg had a threefold increased risk of cardiovascular events, whereas those with diastolic blood pressure <60 mm Hg had a 3.3-fold increased risk of events. Messerli suggested that lowest point of inflection on the morbidity and mortality curves was 140.6 mm Hg for systolic blood pressure and 79.8 mm Hg for diastolic blood pressure.
References
Bakris GL, Sowers JR; on behalf of the American Society of Hypertension Writing Group. ASH Position Paper: Treatment of hypertension in patients with diabetes -- an update. J Clin Hypertens (Greenwich). 2008;10:707-713.
Charles P. Vega .How Effective Are ACE Inhibitors for Hypertension? A Best Evidence Review. Posted Medscape Online 03/13/2009
Heran BS, Wong MM, Heran IK, Wright JM. Blood pressure lowering efficacy of angiotensin converting enzyme (ACE) inhibitors for primary hypertension. Cochrane Database Syst Rev. 2008;(4):CD003823.
Bangalore S, Messerli FH, Wun CC, et al. J-curve revisited: An analysis of blood pressure and cardiovascular events in the Treating to New Targets (TNT) trial. American Society of Hypertension; May 7, 2009; San Francisco, CA.
Tuesday, April 28, 2009
Swine Flu and Infection Risk
The emergence of a new influenza virus has created a frenzy of misinformation and panic. TV news shows people wearing paper face mask, the latest signal that the world is a dangerous place. While I have broadcast my concern for many years that infection surveillance is inadequate and promoted a new ethic of social responsibility, I find the frantic media reports this week to be offensive if not absurd. Social responsibility means -- don't spread infections you have acquired; if you are sick, stay at home.
There are real dangers in the world. Infectious agents evolve continuously. Increasing populations and increasing urban density are ideal for infection transmission. Transportation of people and goods all over the world means that infections become worldwide in a matter of days, not localized. I continue to meet physicians who think they are living in the nineteeth century and refer to localized, "endemic" infection.
Solutions can only be found by well-informed, calm methodical people. Turn off CNN and let us proceed with caution and appropriate concern. In my business, we have looked at air quality issues for several decades. Here is a response to a typical question we addressed:
Question: I do a lot of international flying, from North American to Asia, several times a month. I have gotten, many times, upper respiratory infections, bronchitis, bad coughs that my physicians, as well as my common sense, tells me comes a great deal from the poor air quality on airplanes. In addition, just the past week, with the outburst of some kind of Asian virus with serious symptoms, I want to protect myself as much as possible, while at least on the airplanes. What masks do you suggest, and any other comments or suggestions you might have?
Answer: We have looked at this problem repeatedly over 2 decades and not arrived at a satisfactory method of personal protection except for canceling the flight. You have to accept that traveling involves exposure to thousands of strangers who may infect you with microbes most of which, you have not encountered before and you will lack protective immunity. This increased exposure begins when you leave home and continues even after you arrive back.
You have to disinfect everything, including yourself, before you are free of foreign microbes. It’s easy to focus on the in-flight conditions, but exposure in the aircraft is only a small component of the overall risk of infection when you travel. Biological agents infect through the respiratory mucosa; ingestion; contact with the mucous membranes of the eyes, or nasal tissues; by penetration of the skin through scratches, small cuts and abrasions Organic airborne particles share the same characteristics in air or on surfaces as inorganic particles from hazardous dusts.
Here is a quick summary of the basic strategies you can use:
Disposable paper face masks provide minimal protection against dusts, fungal spores and bacteria, but not viruses. These are obviously the cheapest, most available and probably most acceptable to wear in public including in airports and perhaps on a flight. The protection rating is hard to assess, but is probably very low in the range of 5-10. Paper masks with a NIOSH protection rating of 100 offer better protection against viruses, if you wear them properly.
The mask has to be changed often and you must wash your hands after handling the mask. For more serious protection you can use half-mask or full-face air-purifying respirators with particulate filter efficiencies ranging from N95 (for hazards such as pulmonary tuberculosis) to P100 (for hazards such as viruses). The protection rating is somewhere between 50-200, depending on the filter chosen and degree of proper utilization.
The best protection against airborne infectious agents (as well as all airborne toxins) is provided by self-contained breathing apparatus (SCBA) respirators with a full facepiece operated in a positive pressure mode. This reduces the hazard from most sources -- airborne particles, microbes, chemical vapors and gases. The National Institute for Occupational Safety and Health (NIOSH) suggests that the proper use of SCBA reduces the user’s exposure by at least 10,000.
Decontamination of clothing is a precaution against particles that have settled on the outside. Use detergent, hot water, and 0.5% hypochlorite solution (one part household bleach to 10 parts water) to wash clothes and baggage. You should wash your hands frequently and shower ASAP after a flight using generous quantities of detergent and water. Shampoos contain detergents that tend to be better cleansers than regular soap. Use a basic shampoo as a whole body wash.
Until more people wear APRs and everyone is used to them, we can assume that if you strap one on to go to work, travel in an airplane or walk the dog, most people will think " you look weird!" We are not sure how new security regulations will treat the use of APRs on airplanes… it will controversial.
See the book, Air and Breathing by Stephen Gislason MD
There are real dangers in the world. Infectious agents evolve continuously. Increasing populations and increasing urban density are ideal for infection transmission. Transportation of people and goods all over the world means that infections become worldwide in a matter of days, not localized. I continue to meet physicians who think they are living in the nineteeth century and refer to localized, "endemic" infection.
Solutions can only be found by well-informed, calm methodical people. Turn off CNN and let us proceed with caution and appropriate concern. In my business, we have looked at air quality issues for several decades. Here is a response to a typical question we addressed:
Question: I do a lot of international flying, from North American to Asia, several times a month. I have gotten, many times, upper respiratory infections, bronchitis, bad coughs that my physicians, as well as my common sense, tells me comes a great deal from the poor air quality on airplanes. In addition, just the past week, with the outburst of some kind of Asian virus with serious symptoms, I want to protect myself as much as possible, while at least on the airplanes. What masks do you suggest, and any other comments or suggestions you might have?
Answer: We have looked at this problem repeatedly over 2 decades and not arrived at a satisfactory method of personal protection except for canceling the flight. You have to accept that traveling involves exposure to thousands of strangers who may infect you with microbes most of which, you have not encountered before and you will lack protective immunity. This increased exposure begins when you leave home and continues even after you arrive back.
You have to disinfect everything, including yourself, before you are free of foreign microbes. It’s easy to focus on the in-flight conditions, but exposure in the aircraft is only a small component of the overall risk of infection when you travel. Biological agents infect through the respiratory mucosa; ingestion; contact with the mucous membranes of the eyes, or nasal tissues; by penetration of the skin through scratches, small cuts and abrasions Organic airborne particles share the same characteristics in air or on surfaces as inorganic particles from hazardous dusts.
Here is a quick summary of the basic strategies you can use:
Disposable paper face masks provide minimal protection against dusts, fungal spores and bacteria, but not viruses. These are obviously the cheapest, most available and probably most acceptable to wear in public including in airports and perhaps on a flight. The protection rating is hard to assess, but is probably very low in the range of 5-10. Paper masks with a NIOSH protection rating of 100 offer better protection against viruses, if you wear them properly.
The mask has to be changed often and you must wash your hands after handling the mask. For more serious protection you can use half-mask or full-face air-purifying respirators with particulate filter efficiencies ranging from N95 (for hazards such as pulmonary tuberculosis) to P100 (for hazards such as viruses). The protection rating is somewhere between 50-200, depending on the filter chosen and degree of proper utilization.
The best protection against airborne infectious agents (as well as all airborne toxins) is provided by self-contained breathing apparatus (SCBA) respirators with a full facepiece operated in a positive pressure mode. This reduces the hazard from most sources -- airborne particles, microbes, chemical vapors and gases. The National Institute for Occupational Safety and Health (NIOSH) suggests that the proper use of SCBA reduces the user’s exposure by at least 10,000.
Decontamination of clothing is a precaution against particles that have settled on the outside. Use detergent, hot water, and 0.5% hypochlorite solution (one part household bleach to 10 parts water) to wash clothes and baggage. You should wash your hands frequently and shower ASAP after a flight using generous quantities of detergent and water. Shampoos contain detergents that tend to be better cleansers than regular soap. Use a basic shampoo as a whole body wash.
Until more people wear APRs and everyone is used to them, we can assume that if you strap one on to go to work, travel in an airplane or walk the dog, most people will think " you look weird!" We are not sure how new security regulations will treat the use of APRs on airplanes… it will controversial.
See the book, Air and Breathing by Stephen Gislason MD
Sunday, April 26, 2009
Unsafe? Avandia for Diabetics
There have been a succession of disappointments about drug therapy in recent years. One drug, Avandia, became a popular diabetes medication. It took several years and a brave MD to uncover evidence that it is not such a good drug, after all.
Avandia is rosiglitazone, a popular diabetes 2 drug. Doubts were raised about the safety of this drug and there are arguments for and against it. The arguments and concerns will not be resolved quickly. Avandia is marketed by Glaxo, which, like all drug companies, vigorously defends its big money drugs. Sales of Avandia reached $3.2billion per year in the US.
Our perspective for 2 decades is that the drug treatment of diabetes lacked convincing long-term efficacy and there were important concerns about side effects and long-term adverse effects. Oral medications should not be considered as primary treatment. However, MDs tend to be drug prescribers, drug companies are interested in making money and patients are obedient consumers who like to believe there are simple solutions for complex problems.
Dr. Steven Nissen and colleagues from the Cleveland Clinic reviewed more than 40 studies and concluded that Avandia increased the risk of heart attacks by 43 percent. Psaty and Furberg recalculated Nissen’s analysis using interim results of the Record study in addition to the studies that Nissen used. They found that Avandia increased a patient’s risk of having a heart attack 33 percent. Nissen is an experienced but independent FDA advisor who has become an ombudsman for the American people.
In the US where Avandia was developed and concerns were announced, questions about the safety of Avandia and how regulators have dealt with its risks were asked at Congressional hearing in June 2007. Glaxo had an ongoing study, REPORT, and rushed to submit favorable interim results for publication in advance of the government hearing.
In his New England Journal editorial, Dr. David M. Nathan, a Harvard diabetes expert, doubted the value of the REPORT study because of the high number of patients who dropped out and the study design which compared Avandia to a combination of metformin and sulfonylurea. While this combination is popular, doubts about its safety were raised and never resolved in another study that showed a 96 percent increase in diabetes-related mortality. Metformin alone appears to be relatively free of cardiovascular risk. Nathan concluded that the interim results of the Record trial do not provide any assurance of the safety of treatment with rosiglitazone and suggested that doctors should use medications other than Avandia.
A series of drug adverse effect withdrawals in recently years have generated criticism, that the US Food and Drug Administration fails to protect the public. In the Avandia case, critics say that the US FDA should have warned about the potential heart risks years ago. A supervisor in the drug safety office at the agency said in an interview that she was rebuked after calling for a stronger warning label on Avandia and a competing drug, Actos.
November 20, 2007: A US Senate Committee on Finance released a report describing what it terms the "intimidation" of Dr John Buse by GlaxoSmithKline (GSK) over his concerns about the cardiovascular risks associated with the company's antidiabetes drug rosiglitazone (Avandia). The committee stated: "According to documents provided to the committee by, among others, GSK and the University of North Carolina, it is apparent that the original allegations regarding Dr Buse and GSK’s attempts at silencing him are true. According to relevant emails, GSK executives labeled Dr Buse a 'renegade' and silenced his concerns about Avandia by complaining to his superiors and threatening a lawsuit."
The main problem for a growing number of patients is the false belief that a drug or combination of drugs can rescue an individual from a disease-causing lifestyle. While there may be benefits to be had with medications, a person with diabetes 2 should learn expert self-management skills and exercise all the therapeutic and preventative options available before taking drugs.
From the Book Managing Diabetes 2 by Stephen Gislason MD
See further discussions of medical biases and limitations
Also See Diabetes Drugs
Avandia is rosiglitazone, a popular diabetes 2 drug. Doubts were raised about the safety of this drug and there are arguments for and against it. The arguments and concerns will not be resolved quickly. Avandia is marketed by Glaxo, which, like all drug companies, vigorously defends its big money drugs. Sales of Avandia reached $3.2billion per year in the US.
Our perspective for 2 decades is that the drug treatment of diabetes lacked convincing long-term efficacy and there were important concerns about side effects and long-term adverse effects. Oral medications should not be considered as primary treatment. However, MDs tend to be drug prescribers, drug companies are interested in making money and patients are obedient consumers who like to believe there are simple solutions for complex problems.
Dr. Steven Nissen and colleagues from the Cleveland Clinic reviewed more than 40 studies and concluded that Avandia increased the risk of heart attacks by 43 percent. Psaty and Furberg recalculated Nissen’s analysis using interim results of the Record study in addition to the studies that Nissen used. They found that Avandia increased a patient’s risk of having a heart attack 33 percent. Nissen is an experienced but independent FDA advisor who has become an ombudsman for the American people.
In the US where Avandia was developed and concerns were announced, questions about the safety of Avandia and how regulators have dealt with its risks were asked at Congressional hearing in June 2007. Glaxo had an ongoing study, REPORT, and rushed to submit favorable interim results for publication in advance of the government hearing.
In his New England Journal editorial, Dr. David M. Nathan, a Harvard diabetes expert, doubted the value of the REPORT study because of the high number of patients who dropped out and the study design which compared Avandia to a combination of metformin and sulfonylurea. While this combination is popular, doubts about its safety were raised and never resolved in another study that showed a 96 percent increase in diabetes-related mortality. Metformin alone appears to be relatively free of cardiovascular risk. Nathan concluded that the interim results of the Record trial do not provide any assurance of the safety of treatment with rosiglitazone and suggested that doctors should use medications other than Avandia.
A series of drug adverse effect withdrawals in recently years have generated criticism, that the US Food and Drug Administration fails to protect the public. In the Avandia case, critics say that the US FDA should have warned about the potential heart risks years ago. A supervisor in the drug safety office at the agency said in an interview that she was rebuked after calling for a stronger warning label on Avandia and a competing drug, Actos.
November 20, 2007: A US Senate Committee on Finance released a report describing what it terms the "intimidation" of Dr John Buse by GlaxoSmithKline (GSK) over his concerns about the cardiovascular risks associated with the company's antidiabetes drug rosiglitazone (Avandia). The committee stated: "According to documents provided to the committee by, among others, GSK and the University of North Carolina, it is apparent that the original allegations regarding Dr Buse and GSK’s attempts at silencing him are true. According to relevant emails, GSK executives labeled Dr Buse a 'renegade' and silenced his concerns about Avandia by complaining to his superiors and threatening a lawsuit."
The main problem for a growing number of patients is the false belief that a drug or combination of drugs can rescue an individual from a disease-causing lifestyle. While there may be benefits to be had with medications, a person with diabetes 2 should learn expert self-management skills and exercise all the therapeutic and preventative options available before taking drugs.
From the Book Managing Diabetes 2 by Stephen Gislason MD
See further discussions of medical biases and limitations
Also See Diabetes Drugs
Monday, April 20, 2009
NOT HEALTH CARE
While the term “healthcare” is popular, it misrepresents health in every possible way. Health is supposed to refer to being “healthy” – free of disease, physically fit, productive and happy. Healthy people do not need to spend money on doctor visits, drugs, hospitals and surgery.
So what is a more accurate term than healthcare? Medicalcare is the proper term. Medicalcare is a heterogeneous collection of products and services provided by MDs, drug suppliers and hospitals that deal with people who are not healthy. Sometimes medical intervention is merciful, humane and lifesaving. Most of the time, medical care is wasteful, inefficient and potentially dangerous. Healthy people do not seek medical care.
Lundberg, Editor of MedGenMed stated that: “The US medicalcare system is immensely complicated, almost inexplicable, costly beyond belief, seriously discriminatory, and often unsafe. The money expended from all sources in American medicalcare is extraordinarily large, some $1.7 trillion in 2004, one seventh of the total US economy, and larger than the total economies of most countries of the world.” Lundberg suggests that the marketplace" determines how much money is spent on what and how many people of what types work in medicalcare but it is not a free market. “
People in the US and Canada are less than healthy because they eat too much of the wrong food and exercise too little. The mechanisms of bad-food diseases are numerous and complex. Profit can be made by attempting to manage the consequences of eating too much and exercising too little. Marketing chemicals to reduce the negative effects of eating too much of the wrong food is unbelievably profitable, even though none of the drugs are really required. Canada is the third-highest-per-capita spender on drugs among industrial countries after the United States and France. Canada spent $3,003 US per person in 2003 lower than the U.S. at $5,635. Norway and Switzerland were next in line at $3,800 per capita. All affluent countries are spending more on drugs, increasing 32 per cent between 1998 and 2003 to more than $450 billion annually. Growth in spending on pharmaceuticals outpaced the rise in total health-care expenditures in most countries, including Canada. In the U.S. and Australia, spending on drugs grew more than twice as fast as total health expenditures.
The real solution is not taking drugs, but removing the causes of disease, by, for example, eating less, choosing the right foods and exercising more.
Download free eBooks from Persona Digital
So what is a more accurate term than healthcare? Medicalcare is the proper term. Medicalcare is a heterogeneous collection of products and services provided by MDs, drug suppliers and hospitals that deal with people who are not healthy. Sometimes medical intervention is merciful, humane and lifesaving. Most of the time, medical care is wasteful, inefficient and potentially dangerous. Healthy people do not seek medical care.
Lundberg, Editor of MedGenMed stated that: “The US medicalcare system is immensely complicated, almost inexplicable, costly beyond belief, seriously discriminatory, and often unsafe. The money expended from all sources in American medicalcare is extraordinarily large, some $1.7 trillion in 2004, one seventh of the total US economy, and larger than the total economies of most countries of the world.” Lundberg suggests that the marketplace" determines how much money is spent on what and how many people of what types work in medicalcare but it is not a free market. “
People in the US and Canada are less than healthy because they eat too much of the wrong food and exercise too little. The mechanisms of bad-food diseases are numerous and complex. Profit can be made by attempting to manage the consequences of eating too much and exercising too little. Marketing chemicals to reduce the negative effects of eating too much of the wrong food is unbelievably profitable, even though none of the drugs are really required. Canada is the third-highest-per-capita spender on drugs among industrial countries after the United States and France. Canada spent $3,003 US per person in 2003 lower than the U.S. at $5,635. Norway and Switzerland were next in line at $3,800 per capita. All affluent countries are spending more on drugs, increasing 32 per cent between 1998 and 2003 to more than $450 billion annually. Growth in spending on pharmaceuticals outpaced the rise in total health-care expenditures in most countries, including Canada. In the U.S. and Australia, spending on drugs grew more than twice as fast as total health expenditures.
The real solution is not taking drugs, but removing the causes of disease, by, for example, eating less, choosing the right foods and exercising more.
Download free eBooks from Persona Digital
Wednesday, April 15, 2009
DISAPPOINTED WITH MDS
For many years, I collected reports from patients disappointed in the medical care they received. For several years patients would come into my office and complain that they had seen several doctors, had many investigations and tried many drugs without benefit. I noted that patients routinely left the care of their physicians and shopped around the “alternative” community and bought curious, bizarre and often expensive tests, treatments and products with little hope of benefit.
I am aware of the limitations of physicians, however, and want my well-educated, well-motivated reader to recognize these limitations and assume responsibility for their own management. When you look critically at modern medicine you see expensive techniques deployed to rescue individuals from calamities which were often avoidable. Although many talk about the "health-care system", they are really talking about a high-cost medical intervention system, directed at treating diseases that are fully developed, but not preventing disease. While “high tech” medicine promises miraculous cures, there only is a short list of problems which can be fixed by medical or surgical methods but a much longer list of problems which cannot be fixed.
One problem is that MDs seldom learn how to manage food-related diseases. In the physician’s mind, food is someone else’s responsibility. Physicians, like everyone else, have prejudices and preconceptions that limit their understanding of the complex issues that determine food selection, metabolism and the consequences of bad diets. Both physicians and patients have an overwhelming bias in favor of drug and surgical treatments. Medical practice is based on a routine of ordering tests and writing prescriptions for drugs.
While diet and “life-style” modifications are mentioned in medical texts, few MDs pursue this approach to patient management. Many MDs have argued that the task of changing patients’ habits is beyond their mandate, is too time-consuming, and is often futile. Even if MDs are interested in solving food-related problems, they are usually too rushed to spend the time necessary teach patients the knowledge and skills they require to self-manage effectively.
There is a fundamental misunderstanding between doctors who know something about their limitations and patients who often have unrealistic expectations for fast solutions. Both sides of the relationship become frustrated and tend to act irrationally when quick and easy solutions do not work. The more passive and dependent a patient is, the deeper this misunderstanding grows and the more expensive it becomes. Patients demand more investigations, referrals, and support services. Physicians tend to order more tests and prescribe more drugs and that are increasingly potent and more risky. When neither strategy works, many illnesses remain unsolved, suffering is not relieved and expensive problems continue to drain the resource of individuals and their communities. Stephen Gislason MD
Download Free PDF eBook SelfCare for the 21st Century
I am aware of the limitations of physicians, however, and want my well-educated, well-motivated reader to recognize these limitations and assume responsibility for their own management. When you look critically at modern medicine you see expensive techniques deployed to rescue individuals from calamities which were often avoidable. Although many talk about the "health-care system", they are really talking about a high-cost medical intervention system, directed at treating diseases that are fully developed, but not preventing disease. While “high tech” medicine promises miraculous cures, there only is a short list of problems which can be fixed by medical or surgical methods but a much longer list of problems which cannot be fixed.
One problem is that MDs seldom learn how to manage food-related diseases. In the physician’s mind, food is someone else’s responsibility. Physicians, like everyone else, have prejudices and preconceptions that limit their understanding of the complex issues that determine food selection, metabolism and the consequences of bad diets. Both physicians and patients have an overwhelming bias in favor of drug and surgical treatments. Medical practice is based on a routine of ordering tests and writing prescriptions for drugs.
While diet and “life-style” modifications are mentioned in medical texts, few MDs pursue this approach to patient management. Many MDs have argued that the task of changing patients’ habits is beyond their mandate, is too time-consuming, and is often futile. Even if MDs are interested in solving food-related problems, they are usually too rushed to spend the time necessary teach patients the knowledge and skills they require to self-manage effectively.
There is a fundamental misunderstanding between doctors who know something about their limitations and patients who often have unrealistic expectations for fast solutions. Both sides of the relationship become frustrated and tend to act irrationally when quick and easy solutions do not work. The more passive and dependent a patient is, the deeper this misunderstanding grows and the more expensive it becomes. Patients demand more investigations, referrals, and support services. Physicians tend to order more tests and prescribe more drugs and that are increasingly potent and more risky. When neither strategy works, many illnesses remain unsolved, suffering is not relieved and expensive problems continue to drain the resource of individuals and their communities. Stephen Gislason MD
Download Free PDF eBook SelfCare for the 21st Century
Friday, June 09, 2006
Avoid Stimulant Drugs
Avoid Stimulant Drugs
Stimulant drugs increase the risk of stroke and sudden death. They must be used with caution or avoided. The drugs of concern are epinephrine, norepinephrine, ephedrine, pseudoephedrine, phenylpropanolamine, methyphenidate, ampthetamine, and methamphetamine
Cocaine decreases brain perfusion and increases the risk of ischemic stroke. The intake of caffeine will increase the effect of sympathetic amines that are found in weight loss products, cold remedies, cough syrups, energy drinks, and prescription drugs. Sympathetic amines increase blood pressure, heart rate and decrease brain perfusion. Haller and Benowitz warned that: “Dietary supplements that contain ephedra alkaloids (also known as ma huang) and guarana-derived caffeine are widely consumed in the United States for purposes of weight reduction and energy enhancement. A number of reports of adverse reactions to dietary supplements that contain ephedra alkaloids, some of which resulted in permanent injury or death, have appeared in the medical literature. In response to growing concern about the safety of ephedra alkaloids in dietary supplements, the Food and Drug Administration (FDA) requested an independent review of reports of adverse events related to the use of ephedra alkaloids to assess causation and determine the level of risk these products pose to consumers.”
In the US, a FDA advisory committee heard testimony indicating that 2.5 million children take stimulants for ADHD, including nearly 10 percent of all 10-year-old boys in the United States. The use of these agents is much less prevalent in European countries, where the diagnosis of ADHD is relatively uncommon. The popularity of the diagnosis, Adult ADHD is relatively recent leading to at least 1.5 million adults who take stimulants on a daily basis, with 10 percent of users older than 50 years of age. Drug-related events reviewed by the committee included 25 cases of sudden death in children or adults that included myocardial infarction, stroke, and serious heart arrhythmias. The committee concluded: “We rejected the notion that the administration of potent sympathomimetic agents to millions of Americans is appropriate. We sought to emphasize more selective and restricted use, while increasing awareness of potential hazards. We argued that the FDA should act soon and decisively. “
May 26 2006 Canada's health ministry warned individuals with hypertension, heart disease or abnormalities, arthrosclerosis or hyperthyroidism not to take drugs used to manage attention deficit hyperactivity disorder (ADHD). All ADHD drugs stimulate the heart and blood vessels... in some patients this stimulation may result in cardiac arrests, strokes or death.
The drugs of concern mentioned by Health Canada include:
* Adderall XR
* Concerta
* Ritalin and Ritalin SR
* Dexedrine
* Strattera
For updates on drug warnings see our new page Brain Drug Warnings
Also, read the Book of Brain by Stephen Gislason MD
Stimulant drugs increase the risk of stroke and sudden death. They must be used with caution or avoided. The drugs of concern are epinephrine, norepinephrine, ephedrine, pseudoephedrine, phenylpropanolamine, methyphenidate, ampthetamine, and methamphetamine
Cocaine decreases brain perfusion and increases the risk of ischemic stroke. The intake of caffeine will increase the effect of sympathetic amines that are found in weight loss products, cold remedies, cough syrups, energy drinks, and prescription drugs. Sympathetic amines increase blood pressure, heart rate and decrease brain perfusion. Haller and Benowitz warned that: “Dietary supplements that contain ephedra alkaloids (also known as ma huang) and guarana-derived caffeine are widely consumed in the United States for purposes of weight reduction and energy enhancement. A number of reports of adverse reactions to dietary supplements that contain ephedra alkaloids, some of which resulted in permanent injury or death, have appeared in the medical literature. In response to growing concern about the safety of ephedra alkaloids in dietary supplements, the Food and Drug Administration (FDA) requested an independent review of reports of adverse events related to the use of ephedra alkaloids to assess causation and determine the level of risk these products pose to consumers.”
In the US, a FDA advisory committee heard testimony indicating that 2.5 million children take stimulants for ADHD, including nearly 10 percent of all 10-year-old boys in the United States. The use of these agents is much less prevalent in European countries, where the diagnosis of ADHD is relatively uncommon. The popularity of the diagnosis, Adult ADHD is relatively recent leading to at least 1.5 million adults who take stimulants on a daily basis, with 10 percent of users older than 50 years of age. Drug-related events reviewed by the committee included 25 cases of sudden death in children or adults that included myocardial infarction, stroke, and serious heart arrhythmias. The committee concluded: “We rejected the notion that the administration of potent sympathomimetic agents to millions of Americans is appropriate. We sought to emphasize more selective and restricted use, while increasing awareness of potential hazards. We argued that the FDA should act soon and decisively. “
May 26 2006 Canada's health ministry warned individuals with hypertension, heart disease or abnormalities, arthrosclerosis or hyperthyroidism not to take drugs used to manage attention deficit hyperactivity disorder (ADHD). All ADHD drugs stimulate the heart and blood vessels... in some patients this stimulation may result in cardiac arrests, strokes or death.
The drugs of concern mentioned by Health Canada include:
* Adderall XR
* Concerta
* Ritalin and Ritalin SR
* Dexedrine
* Strattera
For updates on drug warnings see our new page Brain Drug Warnings
Also, read the Book of Brain by Stephen Gislason MD
Brain Prescription Drug Warnings
I have progressed from being an enthusiastic supporter of psychotropic drug research and the therapeutic use of mind drugs 30 years ago, to a disenchanted skeptic who is convinced that drug prescriptions to change mood, attitude, thinking and memory are mostly ill-advised and may often be harmful.
I argue that responsible adults need to become better informed about prescription drugs and exercise constraint when seeking and accepting prescriptions that alter their brain function. I will also argue that prescriptions for psychotropic drugs for children and the elderly are increasing unreasonably and need to be voluntarily constrained by physicians, resisted by family members and controlled by government regulators.
Many, if not most, humans alter their consciousness and behavior by deliberately consuming chemicals to alter they way their brain works. The general principal is that materials that enter human noses and mouths play a role in determining the nature and operation of their mind. We could think of this as the local molecular flow through the brain that alters, expands or contracts the contents of the mind. The brain, as the organ of mind, is the receiving set for the wisdom of the universe. If the receiver is out of tune, not working properly, the wisdom of the universe is either not received at all or the message is garbled.
For updates on drug warnings see our new page Brain Drug Warnings
Also, read the Book of Brain by Stephen Gislason MD
I argue that responsible adults need to become better informed about prescription drugs and exercise constraint when seeking and accepting prescriptions that alter their brain function. I will also argue that prescriptions for psychotropic drugs for children and the elderly are increasing unreasonably and need to be voluntarily constrained by physicians, resisted by family members and controlled by government regulators.
Many, if not most, humans alter their consciousness and behavior by deliberately consuming chemicals to alter they way their brain works. The general principal is that materials that enter human noses and mouths play a role in determining the nature and operation of their mind. We could think of this as the local molecular flow through the brain that alters, expands or contracts the contents of the mind. The brain, as the organ of mind, is the receiving set for the wisdom of the universe. If the receiver is out of tune, not working properly, the wisdom of the universe is either not received at all or the message is garbled.
For updates on drug warnings see our new page Brain Drug Warnings
Also, read the Book of Brain by Stephen Gislason MD
Heart Attacks, Strokes and ASA
The use of drugs in cardiovascular medicine is like fashion in clothes design - always changing. The use of Acetylsalicylic Acid (ASA or Aspirin) taken in a small dose daily, has been advocated for many years to reduce the risk heart attacks and strokes. ASA is a platelet inhibitory drug, effective in doses as low as 50 mg per day.
One major shift in 2006 recommendations is based on noticing differences among men and women of different ages. Ridket and Beller pointed out that 95,000 men and women participated in aspirin prevention trials with a net 24% reduction in myocardial infarction and no benefit on stroke; however if you stratify men and women separately, you get 44,000 men with 32% reduction in heart attack. In contrast the 51,000 women had little or no reductions in myocardial infarction, but a significant 19% reduction in the risk of stroke.
A further study looked at the experience of women over the age of 45 more closely. A total of 39,876 women participated in the trial to receive aspirin 100 mg very other day or placebo. The mean follow-up period was 10.1 years. The primary endpoint was first major cardiovascular event, which included nonfatal MI, nonfatal stroke, or cardiovascular death. Secondary endpoints were the individual endpoints of fatal or nonfatal MI, fatal or nonfatal stroke, ischemic stroke, hemorrhagic stroke, and death from cardiovascular causes. Additional analyses included the incidence of death from any cause, transient ischemic attack (TIA), and the need for coronary revascularization.
The characteristics for the groups were similar; participants were 54.6 years of age and more than half were postmenopausal; slightly more than one-quarter were hypertensive and nearly 85% had a 10-year Framingham risk score < 5%. Ridket stated: “Women over the age of 65, have a benefit of stroke reduction associated with low-dose aspirin. In women under age 65, my feelings are go to the gym, lose weight, eat a healthy diet, and maybe the benefit of aspirin is just smaller than we had hoped.”
The 2006 conclusion? ASA has benefits in the primary and secondary prevention of heart attacks in men with little or no benefit in women. Aspirin has a benefit in women over the age of 65 in the prevention of stroke or transient ischemic attacks. What next?
See the Book of Heart and Arterial Disease
One major shift in 2006 recommendations is based on noticing differences among men and women of different ages. Ridket and Beller pointed out that 95,000 men and women participated in aspirin prevention trials with a net 24% reduction in myocardial infarction and no benefit on stroke; however if you stratify men and women separately, you get 44,000 men with 32% reduction in heart attack. In contrast the 51,000 women had little or no reductions in myocardial infarction, but a significant 19% reduction in the risk of stroke.
A further study looked at the experience of women over the age of 45 more closely. A total of 39,876 women participated in the trial to receive aspirin 100 mg very other day or placebo. The mean follow-up period was 10.1 years. The primary endpoint was first major cardiovascular event, which included nonfatal MI, nonfatal stroke, or cardiovascular death. Secondary endpoints were the individual endpoints of fatal or nonfatal MI, fatal or nonfatal stroke, ischemic stroke, hemorrhagic stroke, and death from cardiovascular causes. Additional analyses included the incidence of death from any cause, transient ischemic attack (TIA), and the need for coronary revascularization.
The characteristics for the groups were similar; participants were 54.6 years of age and more than half were postmenopausal; slightly more than one-quarter were hypertensive and nearly 85% had a 10-year Framingham risk score < 5%. Ridket stated: “Women over the age of 65, have a benefit of stroke reduction associated with low-dose aspirin. In women under age 65, my feelings are go to the gym, lose weight, eat a healthy diet, and maybe the benefit of aspirin is just smaller than we had hoped.”
The 2006 conclusion? ASA has benefits in the primary and secondary prevention of heart attacks in men with little or no benefit in women. Aspirin has a benefit in women over the age of 65 in the prevention of stroke or transient ischemic attacks. What next?
See the Book of Heart and Arterial Disease
Monday, March 06, 2006
Arterial Disease Requires Self-Management
Thinking about common diseases is becoming more sophisticated. Life is a continuing series of interactions between a person and his or her environment. Some of the interactions are healthy and promote long lives. Other interactions are unhealthy and lead to disease. There is a continuum of events that progress from a young healthy body to one with vascular disease, organ dysfunction, organ injury, and finally, death.
No group of diseases has received more attention than diet-related arterial disease. No other diseases have received more public promotion and educational effort both from government agencies and from private fund-raising organizations such as the American and Canadian Heart Associations. When it began, there were two villains in food, cholesterol and salt. Now, we realize that there are many villains, some yet to be discovered. Hyperhomocysteinemia, for example, emerged as an independent risk factor for coronary artery disease. Increased blood concentrations of homocysteine are corrected by supplementation of the diet with folic acid, pyridoxine and optional vitamin B12. Proper mineral intake is protective against high blood pressure and cardiac arrhythmias.
Drug-based research focuses on lowering cholesterol and blood pressure (CBP). Office-based physicians have been recruited to measure these two parameters and prescribe drugs to move measurements into a predetermined “normal range.” The CBP industry consumes vast sums of money and fills libraries with hundreds of journal articles that are often contradictory and confusing. Some of the confusion is generated by the competition for market share among drug companies, some of the confusion is generated by different versions of the physician’s role, and some of the confusion arises from the complexity of biological mechanisms that no one understands very well.
Cardiologists know that atherosclerosis is a disease caused by eating too much of the wrong foods and exercising too little, but they are primarily interested in prescribing drugs. They earn money and gain prestige from knowing about these drugs. They tend to ignore the advantages of changing disease-causing conditions and focus on treating the consequences.
Your family doctor is supposed to help you prevent the disease, but his or her time is limited and resources may be meager at the doctor’s office. The only person in the whole expensive medical/surgical network that can make sense of whole-body arterial disease is the patient. The patient needs to change disease-causing habits.
Because I am convinced that arterial disease is an effect of eating too much of the wrong foods and exercising too little, I advocate complete diet revision. If you are diagnosed with arterial disease, you can be sure that your food choices are wrong and must be changed. You can also be sure you are walking down the wrong path and its time to stop and find a better path. Imagine that you live in a little cottage by the sea, think quiet thoughts, walk everywhere, tend your organic vegetable garden, cultivate fruit trees (never sprayed), and go fishing once or twice per week. Now you have a perfect setting and a perfect diet for enduring good health.
From the Book of Arterial Disease, by Stephen Gislason MD, an intelligent guide to one the most common and most lethal of health problems.
http://www.nutramed.com/publishing/arteriestext.htm
No group of diseases has received more attention than diet-related arterial disease. No other diseases have received more public promotion and educational effort both from government agencies and from private fund-raising organizations such as the American and Canadian Heart Associations. When it began, there were two villains in food, cholesterol and salt. Now, we realize that there are many villains, some yet to be discovered. Hyperhomocysteinemia, for example, emerged as an independent risk factor for coronary artery disease. Increased blood concentrations of homocysteine are corrected by supplementation of the diet with folic acid, pyridoxine and optional vitamin B12. Proper mineral intake is protective against high blood pressure and cardiac arrhythmias.
Drug-based research focuses on lowering cholesterol and blood pressure (CBP). Office-based physicians have been recruited to measure these two parameters and prescribe drugs to move measurements into a predetermined “normal range.” The CBP industry consumes vast sums of money and fills libraries with hundreds of journal articles that are often contradictory and confusing. Some of the confusion is generated by the competition for market share among drug companies, some of the confusion is generated by different versions of the physician’s role, and some of the confusion arises from the complexity of biological mechanisms that no one understands very well.
Cardiologists know that atherosclerosis is a disease caused by eating too much of the wrong foods and exercising too little, but they are primarily interested in prescribing drugs. They earn money and gain prestige from knowing about these drugs. They tend to ignore the advantages of changing disease-causing conditions and focus on treating the consequences.
Your family doctor is supposed to help you prevent the disease, but his or her time is limited and resources may be meager at the doctor’s office. The only person in the whole expensive medical/surgical network that can make sense of whole-body arterial disease is the patient. The patient needs to change disease-causing habits.
Because I am convinced that arterial disease is an effect of eating too much of the wrong foods and exercising too little, I advocate complete diet revision. If you are diagnosed with arterial disease, you can be sure that your food choices are wrong and must be changed. You can also be sure you are walking down the wrong path and its time to stop and find a better path. Imagine that you live in a little cottage by the sea, think quiet thoughts, walk everywhere, tend your organic vegetable garden, cultivate fruit trees (never sprayed), and go fishing once or twice per week. Now you have a perfect setting and a perfect diet for enduring good health.
From the Book of Arterial Disease, by Stephen Gislason MD, an intelligent guide to one the most common and most lethal of health problems.
http://www.nutramed.com/publishing/arteriestext.htm
Thursday, January 19, 2006
Why is Asthma Increasing ?
Asthma is increasing worldwide and higher numbers of deaths from asthma in affluent countries worry authorities. Hospitalization for asthma has increased by 50% over the past 20 years, and deaths from asthma in the United States have increased to 5,000 per year. It is suggested that mortality is particularly high in lower socioeconomic groups who are exposed to higher levels of air pollution and have poorer access to early and effective medical care. Air-borne particulates may be major factor in the increasing morbidity from asthma.
The US Center for Disease Control in Canada reported a threefold increase of asthmatic deaths over 20 years, mostly in teenagers and young adults. Patients with delayed pattern food allergy have the most severe and persistent inflammatory form of chronic asthma.
Asthma is a form of reactive lung disease with many variations. In the past, medical textbooks divided asthma into outside and inside forms. Extrinsic (outside) asthma tended to occur in sudden attacks triggered by exposure to airborne materials. Intrinsic (inside) asthma seemed to occur repeatedly or continuously for no apparent reason.
Airborne allergens and chemicals cause respiratory disease - inflammation in the nose and in the lung. Lung inflammation is often expressed as asthma. Air pollution, both indoor and outdoor, can play a role in the exacerbation of airway disease in asthmatics and may contribute to the overall increase in asthma morbidity in recent decades. The most serious airborne problems at home are cigarette smoke, dust, molds, and house dust mites.
Food allergy is a hidden cause of asthma. Food-induced wheezing is sometimes recognized in infants who often have food allergy especially to cow’s milk. Asthma and eczema often go together in infants and young children. Food allergy is seldom recognized in older children, adolescents and adults and diet revision is almost never considered in the treatment of asthma. This is a tragic oversight.
Since asthmatics are often allergic and hypersensitive individuals, it is common for an asthmatic to react to both airborne and food triggers and to develop more complex sensitivities as they progress along the disease path.
The good news is that complete diet revision lead to a remission of some if not all chronic symptoms. Asthma that seems to originate inside the body (intrinsic asthma) should be treated as food allergy until proven otherwise. This assumption should lead to careful diet revision. Our patients usually have asthma with associated symptoms that suggest a whole-body food allergy problem. A comprehensive management plan will include solving the food allergy problem, solving airborne allergy and toxicity, and providing the right medication, at the right doses and at the right time when preventive efforts fail.
Please see the Book of Breathing by Stephen Gislason MD
The US Center for Disease Control in Canada reported a threefold increase of asthmatic deaths over 20 years, mostly in teenagers and young adults. Patients with delayed pattern food allergy have the most severe and persistent inflammatory form of chronic asthma.
Asthma is a form of reactive lung disease with many variations. In the past, medical textbooks divided asthma into outside and inside forms. Extrinsic (outside) asthma tended to occur in sudden attacks triggered by exposure to airborne materials. Intrinsic (inside) asthma seemed to occur repeatedly or continuously for no apparent reason.
Airborne allergens and chemicals cause respiratory disease - inflammation in the nose and in the lung. Lung inflammation is often expressed as asthma. Air pollution, both indoor and outdoor, can play a role in the exacerbation of airway disease in asthmatics and may contribute to the overall increase in asthma morbidity in recent decades. The most serious airborne problems at home are cigarette smoke, dust, molds, and house dust mites.
Food allergy is a hidden cause of asthma. Food-induced wheezing is sometimes recognized in infants who often have food allergy especially to cow’s milk. Asthma and eczema often go together in infants and young children. Food allergy is seldom recognized in older children, adolescents and adults and diet revision is almost never considered in the treatment of asthma. This is a tragic oversight.
Since asthmatics are often allergic and hypersensitive individuals, it is common for an asthmatic to react to both airborne and food triggers and to develop more complex sensitivities as they progress along the disease path.
The good news is that complete diet revision lead to a remission of some if not all chronic symptoms. Asthma that seems to originate inside the body (intrinsic asthma) should be treated as food allergy until proven otherwise. This assumption should lead to careful diet revision. Our patients usually have asthma with associated symptoms that suggest a whole-body food allergy problem. A comprehensive management plan will include solving the food allergy problem, solving airborne allergy and toxicity, and providing the right medication, at the right doses and at the right time when preventive efforts fail.
Please see the Book of Breathing by Stephen Gislason MD
Monday, November 07, 2005
The Concept of Allergy
The concept of immune responses to food antigens is useful in understanding many diseases. Many of the major unsolved disease of our civilization are either degenerative and/or inflammatory and many are recognized to be inflammatory, immune-mediated, hypersensitivity diseases. In this review, a general theory of hypersensitivity disease as a continuum of disease-causing mechanisms is presented.
The term "hypersensitivity" refers to immune-mediated processes that lead to disease. For over 20 years, I have considered the possible role of food antigens in causing or contributing to immune-mediated diseases and looked for opportunities to help patients with simple and safe therapeutic strategies such as diet revision. The original concept of allergy included all immune-mediated disease and the term allergy was interchangeable with the term "hypersensitivity."
Allergy can be thought of as hypersensitivity disorders with external causes. Substances that trigger allergic responses are antigens. These are often proteins that can be found in air, food and water. Airborne antigens such as plant pollens or house dust are well known. Other airborne antigens and food antigens are less obvious. New and foreign substances introduced to the body such as drugs and herbs cause allergic reactions.
Food materials should be given priority consideration since this is the biggest chunk of the environment to get inside human bodies and to interact with immune networks. If the term "food allergy" refers to all interactions between molecules derived from the food supply and the immune system, then many hypersensitivity disorders fall into the category of food allergy. Diverse manifestations of food allergy can only be understood if different patterns of immune activity are appreciated. It is unreasonable to believe that all food allergy can be detected by skin tests or any other simple test.
The first distinction that recurs in the allergy literature is between immediate and delayed patterns of allergic reactivity that loosely correspond to IgE-mediated allergy and non-IgE mediated responses. Many authors refer to the original four categories of immune-mediated injury defined by Gell and Coombs. The concept of four mechanisms is just a starting point for understanding immune-mediated disease. These very complicated defense-injury sequences cause a variety of disease states.
The immediate or type 1 allergy pattern is easily recognized because it involves quick and dramatic symptoms. Hay fever is the most common type 1 allergy and can be diagnosed by allergy skin tests and by IgE antibody tests such as RAST or ELIZA. Delayed patterns of allergy are not so obvious and generally go unrecognized. Allergy skin tests do not show this problem. Symptom onset is delayed many hours after exposure to the trigger. Allergic reactions to drugs such as penicillin and to foods involve delayed hypersensitivity.
The advocates of a broad definition of food allergy run the risk of being evangelical. The conviction that food allergy is a ubiquitous cause of disease comes from knowing the benefits of careful diet revision in medical practice. Many books in the popular literature proclaim the benefits of diet revision and a ground swell of interest and concern has engaged an ever-enlarging group of patients.
Often, the patient who benefits from proper diet revision is distanced from a medical profession who is either not interested or denies the problem of food allergy. Some of the issues that arise are semantic and political, but other issues involve the very complex biology of food-body interactions that are not well understood. Other issues involve the changes in the food supply that have accelerated in the past few decades.
When you do not know about food allergy, you are surrounded by mysterious diseases. When you know about food allergy, several common illness patterns begin to make more sense. Linda Gamlin writing about food allergy in the New Scientist stated that:
"Evidence is growing that many debilitating and chronic symptoms of ill health come from an intolerance for certain foods… The medical establishment remains largely hostile to the notion, leaving the field open to the medical fringe… the main problem is the plethora of symptoms and the variations from one patient to another. Doctors working with food intolerance report more than 40 possible symptoms and conditions...the severity also varies. Some patients are said to have nothing more than the occasional migraine or bout of fatigue, while at the other end of the scale the sufferer is unable to work or lead any sort of normal life."
In response to allergy lobby groups in the USA, the US Congress passed a bill that requires notice on the labels of foodstuffs that contain eight of the most common food allergens. The Food Allergen Labeling and Consumer Protection Act, will require plain English labeling by the year 2006 of products containing wheat, milk, soy, peanuts, tree nuts, fish, shellfish, or eggs. These account for an estimated 90% of all food allergies. The bill also requires the Food and Drug Administration to develop a definition of the term "gluten-free" to help those with celiac disease and who require a gluten free diet for other reasons.
See Allergy and Immunology by Stephen Gislason MD
The term "hypersensitivity" refers to immune-mediated processes that lead to disease. For over 20 years, I have considered the possible role of food antigens in causing or contributing to immune-mediated diseases and looked for opportunities to help patients with simple and safe therapeutic strategies such as diet revision. The original concept of allergy included all immune-mediated disease and the term allergy was interchangeable with the term "hypersensitivity."
Allergy can be thought of as hypersensitivity disorders with external causes. Substances that trigger allergic responses are antigens. These are often proteins that can be found in air, food and water. Airborne antigens such as plant pollens or house dust are well known. Other airborne antigens and food antigens are less obvious. New and foreign substances introduced to the body such as drugs and herbs cause allergic reactions.
Food materials should be given priority consideration since this is the biggest chunk of the environment to get inside human bodies and to interact with immune networks. If the term "food allergy" refers to all interactions between molecules derived from the food supply and the immune system, then many hypersensitivity disorders fall into the category of food allergy. Diverse manifestations of food allergy can only be understood if different patterns of immune activity are appreciated. It is unreasonable to believe that all food allergy can be detected by skin tests or any other simple test.
The first distinction that recurs in the allergy literature is between immediate and delayed patterns of allergic reactivity that loosely correspond to IgE-mediated allergy and non-IgE mediated responses. Many authors refer to the original four categories of immune-mediated injury defined by Gell and Coombs. The concept of four mechanisms is just a starting point for understanding immune-mediated disease. These very complicated defense-injury sequences cause a variety of disease states.
The immediate or type 1 allergy pattern is easily recognized because it involves quick and dramatic symptoms. Hay fever is the most common type 1 allergy and can be diagnosed by allergy skin tests and by IgE antibody tests such as RAST or ELIZA. Delayed patterns of allergy are not so obvious and generally go unrecognized. Allergy skin tests do not show this problem. Symptom onset is delayed many hours after exposure to the trigger. Allergic reactions to drugs such as penicillin and to foods involve delayed hypersensitivity.
The advocates of a broad definition of food allergy run the risk of being evangelical. The conviction that food allergy is a ubiquitous cause of disease comes from knowing the benefits of careful diet revision in medical practice. Many books in the popular literature proclaim the benefits of diet revision and a ground swell of interest and concern has engaged an ever-enlarging group of patients.
Often, the patient who benefits from proper diet revision is distanced from a medical profession who is either not interested or denies the problem of food allergy. Some of the issues that arise are semantic and political, but other issues involve the very complex biology of food-body interactions that are not well understood. Other issues involve the changes in the food supply that have accelerated in the past few decades.
When you do not know about food allergy, you are surrounded by mysterious diseases. When you know about food allergy, several common illness patterns begin to make more sense. Linda Gamlin writing about food allergy in the New Scientist stated that:
"Evidence is growing that many debilitating and chronic symptoms of ill health come from an intolerance for certain foods… The medical establishment remains largely hostile to the notion, leaving the field open to the medical fringe… the main problem is the plethora of symptoms and the variations from one patient to another. Doctors working with food intolerance report more than 40 possible symptoms and conditions...the severity also varies. Some patients are said to have nothing more than the occasional migraine or bout of fatigue, while at the other end of the scale the sufferer is unable to work or lead any sort of normal life."
In response to allergy lobby groups in the USA, the US Congress passed a bill that requires notice on the labels of foodstuffs that contain eight of the most common food allergens. The Food Allergen Labeling and Consumer Protection Act, will require plain English labeling by the year 2006 of products containing wheat, milk, soy, peanuts, tree nuts, fish, shellfish, or eggs. These account for an estimated 90% of all food allergies. The bill also requires the Food and Drug Administration to develop a definition of the term "gluten-free" to help those with celiac disease and who require a gluten free diet for other reasons.
See Allergy and Immunology by Stephen Gislason MD
Saturday, November 05, 2005
What is Intelligence ?
The central feature of intelligence is the ability to understand what is really going on out there and to respond to events with successful and adaptive behavior. Intelligence is built from subsystems that sense, decide, remember and act. It is fashionable to speak in terms of "mental abilities" and to list a number of different mental abilities. Obvious differences in individual mental abilities are measured with standardized tests which are then correlated with performance in school, skills learned, and with other socio-economic measurements. Intelligence test measurements tend to be used as a short-form for general intelligence. Arguments arise when test results are not congruent with preconceptions and vested interests.
Leda Cosmides and John Tooby suggest:
“The brain is a naturally constructed computational system whose function is to solve adaptive information-processing problems (such as face recognition, threat interpretation, language acquisition, or navigation). Over evolutionary time, its circuits were cumulatively added because they "reasoned" or "processed information" in a way that enhanced the adaptive regulation of behavior and physiology....our minds consist of a large number of circuits that are specialized. For example, we have some neural circuits whose design is specialized for vision. All they do is help you see. The design of other neural circuits is specialized for hearing. All they do is detect changes in air pressure, and extract information from it. Still other neural circuits are specialized for sexual attraction -- i.e., they govern what you find sexually arousing, what you regard as beautiful, who you'd like to date, and so on.… you can view the brain as a collection of dedicated mini-computers -- a collection of modules… whose operations are functionally integrated to produce behavior...So it is with your conscious experience. The only things you become aware of are a few high level conclusions passed on by thousands of specialized mechanisms: some that are gathering sensory information from the world, others that are analyzing and evaluating that information, checking for inconsistencies, filling in the blanks, figuring out what it all means.“
The other day, I was in the hardware store getting some plumbing parts and I heard one clerk tell his colleague: "If you yawn, that means there's no oxygen. I mean if you walk into a room and start to yawn there no oxygen there. It's a fact!" Perhaps the clerk should get an award for attempting science but he did not get it right. He is manifesting the human tendency to develop explanatory systems with the information at hand. Everyone has a science and technology. The question is how intelligent and up-to-date is your version of science and technology?
Many people are content with the most available explanations and will not make the effort or do not have the ability to study current science and technology. Some people are quite satisfied with explanations provided by astrology, for example, and make no effort to learn the up-to-date sciences of astronomy and psychology. Astrology might have been a viable science 1000 years ago but in the 21st century, astrology is a historical curiosity that should be in a museum and not in daily use. Irrational explanations reflect a deep human tendency to interpret events superstitiously and with exaggerated self-reference. Advanced education, carefully modeled and supervised by more rational teachers is required to replace irrational explanations with more rational ones.
Common usage of the word "intelligence" involves a scale, not a single value or entity. Humans rate each other on a scale of smart to dumb, or bright to stupid. The idea is that intelligence varies and this means that the ability to understand what is really going on out there is unevenly distributed in any human population. The ability to respond to events with successful and adaptive behavior is a variable expression of intelligence.
The problem with the hardware store clerk's assertion is that the premise is wrong. No oxygen leads to coma and death, not yawning. And yet, there is something appealing about the clerks' interest in the problem and his certainly that he knows what is really going on. His statement is representative of an entire class of human statements that sound like intelligent remarks but are not. When people do not really understand what is going on out there, their statements are wrong, their actions are wrong and the consequences of their actions can be harmful to themselves and others. Some of the errors can be attributed to the habits of a lazy mind, to ignorance, misinformation and some of the error to lack of innate ability. You could imagine a very bright child who was taught all the wrong things at home and at school, he or she would make mistakes because of no information or misinformation. You could also imagine a not-so smart child who was taught all the right things but did not understand or forgot.
The real question is: How do the innate determinants of intelligence and learning interact? You might observe some bright children who were taught all the wrong things and at some point in their life, realize that their teachers misled them and invent new ideas and new strategies, learning through their mistakes. The adaptive principle of intelligence suggests that if you got the wrong direction and the wrong information from your parents and teachers and you are smart, you have a chance to discover your own truth.
From the The Book of Brain
by Stephen J. Gislason MD
Leda Cosmides and John Tooby suggest:
“The brain is a naturally constructed computational system whose function is to solve adaptive information-processing problems (such as face recognition, threat interpretation, language acquisition, or navigation). Over evolutionary time, its circuits were cumulatively added because they "reasoned" or "processed information" in a way that enhanced the adaptive regulation of behavior and physiology....our minds consist of a large number of circuits that are specialized. For example, we have some neural circuits whose design is specialized for vision. All they do is help you see. The design of other neural circuits is specialized for hearing. All they do is detect changes in air pressure, and extract information from it. Still other neural circuits are specialized for sexual attraction -- i.e., they govern what you find sexually arousing, what you regard as beautiful, who you'd like to date, and so on.… you can view the brain as a collection of dedicated mini-computers -- a collection of modules… whose operations are functionally integrated to produce behavior...So it is with your conscious experience. The only things you become aware of are a few high level conclusions passed on by thousands of specialized mechanisms: some that are gathering sensory information from the world, others that are analyzing and evaluating that information, checking for inconsistencies, filling in the blanks, figuring out what it all means.“
The other day, I was in the hardware store getting some plumbing parts and I heard one clerk tell his colleague: "If you yawn, that means there's no oxygen. I mean if you walk into a room and start to yawn there no oxygen there. It's a fact!" Perhaps the clerk should get an award for attempting science but he did not get it right. He is manifesting the human tendency to develop explanatory systems with the information at hand. Everyone has a science and technology. The question is how intelligent and up-to-date is your version of science and technology?
Many people are content with the most available explanations and will not make the effort or do not have the ability to study current science and technology. Some people are quite satisfied with explanations provided by astrology, for example, and make no effort to learn the up-to-date sciences of astronomy and psychology. Astrology might have been a viable science 1000 years ago but in the 21st century, astrology is a historical curiosity that should be in a museum and not in daily use. Irrational explanations reflect a deep human tendency to interpret events superstitiously and with exaggerated self-reference. Advanced education, carefully modeled and supervised by more rational teachers is required to replace irrational explanations with more rational ones.
Common usage of the word "intelligence" involves a scale, not a single value or entity. Humans rate each other on a scale of smart to dumb, or bright to stupid. The idea is that intelligence varies and this means that the ability to understand what is really going on out there is unevenly distributed in any human population. The ability to respond to events with successful and adaptive behavior is a variable expression of intelligence.
The problem with the hardware store clerk's assertion is that the premise is wrong. No oxygen leads to coma and death, not yawning. And yet, there is something appealing about the clerks' interest in the problem and his certainly that he knows what is really going on. His statement is representative of an entire class of human statements that sound like intelligent remarks but are not. When people do not really understand what is going on out there, their statements are wrong, their actions are wrong and the consequences of their actions can be harmful to themselves and others. Some of the errors can be attributed to the habits of a lazy mind, to ignorance, misinformation and some of the error to lack of innate ability. You could imagine a very bright child who was taught all the wrong things at home and at school, he or she would make mistakes because of no information or misinformation. You could also imagine a not-so smart child who was taught all the right things but did not understand or forgot.
The real question is: How do the innate determinants of intelligence and learning interact? You might observe some bright children who were taught all the wrong things and at some point in their life, realize that their teachers misled them and invent new ideas and new strategies, learning through their mistakes. The adaptive principle of intelligence suggests that if you got the wrong direction and the wrong information from your parents and teachers and you are smart, you have a chance to discover your own truth.
From the The Book of Brain
by Stephen J. Gislason MD
Thursday, September 22, 2005
Packaged Diseases - 5 major health problems in one
Heart and Arterial Disease
Diseases of blood vessels are a major cause of premature disability and death. Heart attacks and strokes are the most devastating consequences of damaged arteries and increased clotting of blood. The main event is the rupture of an atherosclerotic plaque and the subsequent occlusion of the artery by a blood clot. No group of diseases has received more attention than diet-related arterial disease. No other diseases have received more public promotion and educational effort both from government agencies and from private fund-raising organizations such as the American and Canadian Heart Associations.
Arterial disease is a whole body disease, but tends to be managed by physicians and surgeons as a localized disease. In other words, when the heart arteries are plugged you go to see a cardiologist and then a heart surgeon. When the vessels to the brain are involved, you go to a neurologist and then possibly a neurosurgeon. When the vessels to your leg are obstructed, you go to a peripheral vascular surgeon. When the vessels to your penis are plugged, you go to an urologist and a marital counselor.
Arterial disease is part of a package deal of disease manifestations that are caused any eating too much of the wrong foods, exercising too little and otherwise indulging in unhealthy habits such as smoking and overindulging in alcoholic beverages. Environmental factors such as air pollution with chemicals produced by the combustion of petroleum products and other fuels contributes to the body burden of disease. Each component in this package deal tends to have separate support and lobby groups that champion vested interests. Doctors tend to specialize in one component of the overall package. Thus diabetes is separated from obesity and obesity is separated from hypertension, often treated as a separate issue from coronary artery disease, which is separated from strokes. Getting all the specialized vested interests together has proved to be an impossible task.
You might have assumed that your family doctor is supposed to help you prevent all these disease, but his or her time is limited and preventive resources are meager at the doctor’s office. It turns you that the only person in the whole expensive medical/surgical network that can make sense of whole package deal - arterial disease and all its associated disorders - is the patient. It is up to you, dear reader to solve this collection of health problems by removing the causes! This book is dedicated to the effort of intelligent well-motivated people to become well-informed and to take charge of their own management. A non-smoking, fitness center that serves Alpha Nutrition Program meals can replace hospitals, clinics, MDs offices, rehab programs and nursing homes.
Normally Abnormal
Thinking about common diseases is becoming more sophisticated. Life is a continuing series of interactions between a person and his or her environment. Some of the interactions are healthy and promote long lives. Other interactions are unhealthy and lead to disease. There is a continuum of events that progress from a young healthy body to one with vascular disease, organ dysfunction, organ injury, and finally, death.
Most of us would like to be health, productive and live a long life. Most of us have some control over interactions with our environment. We know that the critical dominants of disease are within the range of personal choices. When a person develops overt cardiovascular disease, we can usually conclude that they made poor choices consistently over many years. There are many reasons for wrong choices, beginning with ignorance. Some ignorance is a result of lack of understanding, but most ignorance is active ignoring and denying the harmful consequences of bad choices made. Obviously, the sooner that bad choices are corrected, the better the results in the long term.
Cardiologists realize that medical interventions tend to occur late in the disease continuum if at all. People in their 20s and 30s can have fatty plaque in their coronary arteries, but may not show up for medical care until they are older than 60 years. The evidence does suggest that some interventions are beneficial in terms of preventing heart attacks and strokes and that disease progression can be halted by important changes in diet and increased exercise. The occurrence of a heart attack or stroke conforms that atherosclerosis is advanced, damage has been done and that the rules of intervention have changed.
In a discussion of the progression of atherosclerosis, Weintraub suggested: “I think it is important that we recognize that this process is not something that we were supposed to have to endure. We eat things that are wrong and our lipid levels are far higher than they were ever designed to be, and as a consequence we are experiencing injuries that were never part of our biologic programming. Think of the renin-angiotensin-aldosterone (RAAS) system, which has direct pathobiologic effects on a variety of tissues. It was designed to be part of a repair or temporary compensation system. The problem is that we humans end up with the RAAS in the constant "on" position and we are constantly suffering oxidative injury from the oxidized lipids we graze on. We are not born with the ability to successfully handle the overload we place on our system, and this is why we develop heart failure after an MI -- because our normal, healthy, compensatory system is ill-suited for our bad behavior.”
There are many risk factor measurements in common use such as cholesterol, LDH and HDL. While risk factors are relevant, they do not reveal what everyone really wants to know – how much arterial damage already exists and how fast is it progressing. Weintraub suggested using two non-invasive tests: 1. measure microalbuminuria in the urine and 2. measure carotid artery intimal-medial thickening (IMT). Increasing carotid artery IMT and microalbuminuria show progression toward tissue damage. Stable or decreasing carotid IMT would be most reassuring.. He potions out that microalbuminuria is not an expensive test and carotid artery IMT is not less expensive than echocardiography. While an ECG is not expensive, it reveals only existing heart damage and is not predictive of progression of coronary artery disease.
From the Book of Heart and Arteries by Stephen Gislason MD
http://www.nutramed.com/artery/
Diseases of blood vessels are a major cause of premature disability and death. Heart attacks and strokes are the most devastating consequences of damaged arteries and increased clotting of blood. The main event is the rupture of an atherosclerotic plaque and the subsequent occlusion of the artery by a blood clot. No group of diseases has received more attention than diet-related arterial disease. No other diseases have received more public promotion and educational effort both from government agencies and from private fund-raising organizations such as the American and Canadian Heart Associations.
Arterial disease is a whole body disease, but tends to be managed by physicians and surgeons as a localized disease. In other words, when the heart arteries are plugged you go to see a cardiologist and then a heart surgeon. When the vessels to the brain are involved, you go to a neurologist and then possibly a neurosurgeon. When the vessels to your leg are obstructed, you go to a peripheral vascular surgeon. When the vessels to your penis are plugged, you go to an urologist and a marital counselor.
Arterial disease is part of a package deal of disease manifestations that are caused any eating too much of the wrong foods, exercising too little and otherwise indulging in unhealthy habits such as smoking and overindulging in alcoholic beverages. Environmental factors such as air pollution with chemicals produced by the combustion of petroleum products and other fuels contributes to the body burden of disease. Each component in this package deal tends to have separate support and lobby groups that champion vested interests. Doctors tend to specialize in one component of the overall package. Thus diabetes is separated from obesity and obesity is separated from hypertension, often treated as a separate issue from coronary artery disease, which is separated from strokes. Getting all the specialized vested interests together has proved to be an impossible task.
You might have assumed that your family doctor is supposed to help you prevent all these disease, but his or her time is limited and preventive resources are meager at the doctor’s office. It turns you that the only person in the whole expensive medical/surgical network that can make sense of whole package deal - arterial disease and all its associated disorders - is the patient. It is up to you, dear reader to solve this collection of health problems by removing the causes! This book is dedicated to the effort of intelligent well-motivated people to become well-informed and to take charge of their own management. A non-smoking, fitness center that serves Alpha Nutrition Program meals can replace hospitals, clinics, MDs offices, rehab programs and nursing homes.
Normally Abnormal
Thinking about common diseases is becoming more sophisticated. Life is a continuing series of interactions between a person and his or her environment. Some of the interactions are healthy and promote long lives. Other interactions are unhealthy and lead to disease. There is a continuum of events that progress from a young healthy body to one with vascular disease, organ dysfunction, organ injury, and finally, death.
Most of us would like to be health, productive and live a long life. Most of us have some control over interactions with our environment. We know that the critical dominants of disease are within the range of personal choices. When a person develops overt cardiovascular disease, we can usually conclude that they made poor choices consistently over many years. There are many reasons for wrong choices, beginning with ignorance. Some ignorance is a result of lack of understanding, but most ignorance is active ignoring and denying the harmful consequences of bad choices made. Obviously, the sooner that bad choices are corrected, the better the results in the long term.
Cardiologists realize that medical interventions tend to occur late in the disease continuum if at all. People in their 20s and 30s can have fatty plaque in their coronary arteries, but may not show up for medical care until they are older than 60 years. The evidence does suggest that some interventions are beneficial in terms of preventing heart attacks and strokes and that disease progression can be halted by important changes in diet and increased exercise. The occurrence of a heart attack or stroke conforms that atherosclerosis is advanced, damage has been done and that the rules of intervention have changed.
In a discussion of the progression of atherosclerosis, Weintraub suggested: “I think it is important that we recognize that this process is not something that we were supposed to have to endure. We eat things that are wrong and our lipid levels are far higher than they were ever designed to be, and as a consequence we are experiencing injuries that were never part of our biologic programming. Think of the renin-angiotensin-aldosterone (RAAS) system, which has direct pathobiologic effects on a variety of tissues. It was designed to be part of a repair or temporary compensation system. The problem is that we humans end up with the RAAS in the constant "on" position and we are constantly suffering oxidative injury from the oxidized lipids we graze on. We are not born with the ability to successfully handle the overload we place on our system, and this is why we develop heart failure after an MI -- because our normal, healthy, compensatory system is ill-suited for our bad behavior.”
There are many risk factor measurements in common use such as cholesterol, LDH and HDL. While risk factors are relevant, they do not reveal what everyone really wants to know – how much arterial damage already exists and how fast is it progressing. Weintraub suggested using two non-invasive tests: 1. measure microalbuminuria in the urine and 2. measure carotid artery intimal-medial thickening (IMT). Increasing carotid artery IMT and microalbuminuria show progression toward tissue damage. Stable or decreasing carotid IMT would be most reassuring.. He potions out that microalbuminuria is not an expensive test and carotid artery IMT is not less expensive than echocardiography. While an ECG is not expensive, it reveals only existing heart damage and is not predictive of progression of coronary artery disease.
From the Book of Heart and Arteries by Stephen Gislason MD
http://www.nutramed.com/artery/
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