Stayin' Alive : Picking a Health Care Provider

Stayin' Alive:
Tips on choosing your health care provider

By Mariann G. Wizard / The Rag Blog / February 2, 2010

[Stayin' Alive is a periodic column on Complementary and Alternative Medicine by Rag Blogger Mariann G. Wizard, a professional science writer with a wide-ranging knowledge of natural health therapies. Readers may suggest topics for future columns, within the restrictions suggested below, in the Comments section of The Rag Blog.]

If there is any advantage to paying my own medical bills, as I do with a so-called "Health Savings Account" and high-deductible insurance (the only real alternative for self-employed Americans), it is that I'm free to choose my own health care providers. No list of "in-network" doctors or HMO-approved dentists for me!

Having experienced "managed care" very briefly, I appreciate the choices I now have. Still, even for people whose choices are limited by geography or bureaucracy, there are ways to get a better "fit" with your partners in health.

Before meeting a prospective new health care provider, I like to refresh myself on the issues and questions that are important to me. For me, first and foremost, I want to be an equal partner in the health care decisions that affect my life. For you, it may be something entirely different. But make your priorities clear and ask the health care provider you're considering how they prefer to operate.

Admittedly I am an extremist in this regard. I adore my vehicle mechanics, in part, because they will show me, in however much detail I want, exactly what is going on with my car, what needs to be done, and how to avoid recurring problems. I want my doctor to do the same. Some people prefer to have an annual physical, and take whatever pills they're "given" for vague complaints, such as "my heart", or "sugar". Suit yourself, but this is a choice on your part; you need not be simply putty in Doctor's hands!

Ask questions. Always, unless you are meeting a provider for the first time in an emergency situation, schedule a first visit to get acquainted and to become an "established patient." Do you prefer a physician who is "hands-on" or one who allocates most routine tasks to a nurse or assistant? If a nurse or assistant is who you'll mostly interact with, meet that person as well as the primary provider.

I want to know where a provider studied and how long they've been in practice. I usually prefer someone who isn't brand new, but is also young enough (at least, when I establish myself as a patient) to know the latest information, and hopefully to be in business for a long time to come.

I like stability. I've seen a wonderful dentist, an eye doctor, and a chiropractor each for many years, and have been known to travel many miles to see them when needed. One good indicator of stability may be how long physicians or other professionals keep their staff. Frequent staff turnover, to me, warns of someone whose emotions may interfere with business; I don't want it to interfere with their analysis of my health status. Also, frequent staff turnover may, in a worst-case scenario, compromise the confidentiality of medical files or other personal information.

For your own part, be as honest as the law allows. Do you take dietary supplements? Drink a lot? Play contact sports? Have frequent black-outs? Tell the nice man or lady; they can't help you if you play coy. People with high blood pressure have been known to "fudge" results they report to their physicians; why do they even go??

Now, honesty can sometimes have unanticipated and even inconvenient results. In 1979, expecting my first and, as it would develop, only child, I had an obstetrician-gynecologist (OB-GYN) I liked, one of Austin's best baby-catchers who I had first seen a few years earlier and had seen annually in the interim. Everything was going swell, and I was a model patient until, at eight months gestation, I told him that my partner and I, in addition to Lamaze classes at his office, were taking home birth classes with the Austin Lay Midwives Association (ALMA) and were "considering" a home delivery.

At that time, midwives were not allowed to assist births at any Austin-area hospitals, and the first "birthing suites" had yet to be imagined. My doctor ordered me out of his office and said I couldn't come back until I in, effect, renounced heretical thought.

If you know me at all, you know how well that went over! Thanks to ALMA, and to Austin's best-beloved West Campus-area general practitioner (GP), Dr. Milton Railey of blessed memory, and to a truly dreadful emergency room butcher at the old Brackenridge Hospital, my son came into the world without my former OB-GYN's involvement. If I'd told him a few months earlier that my baby-daddy and I wanted a home birth, it might have gone a lot smoother, or we'd at least have been better prepared for what turned out to be the scary part!

Some part of me knew that my OB-GYN wasn't going to appreciate my "irresponsible" notions, and lacked the courage to tell him of them early on. Never again. Now, I try to think of issues that may arise and address them in advance, and strongly recommend that women of child-bearing age ask their regular doctor and/or gynecologist their professional and private opinions of matters such as birth control and abortion, and discuss whether those private opinions ever influence their professional actions.

In choosing any practitioner, whether dentist, dermatologist, or witch doctor, don't be shy. If you're uncomfortable with anything about a person, their practice, or their methods, speak up right away. I once changed dentists because the fellow who'd bought my former dentist's practice had lab coats that matched his garish, I'm not kidding you, office wallpaper, but was pinché with the nitrous oxide!

Some issues can be easily resolved with frank communication; if not, you're under no obligation to see a provider you don't trust, don't like, or about whom you have serious reservations. Yes, it may cost you some dinero to get established with a new provider. Suck it up; there is nothing worse for your health than a provider who distresses you!

Oh and hey, a little word to the wise? Health care providers sometimes forget to wash their hands between patients! I really prefer, if someone is going to put their hands professionally into any of my body cavities, to see them wash their mitts and put on new protective gloves beforehand. I will ask, in a hospital setting, anyone who comes near me to wash up where I can see it!

When it works

Physicians, naturopaths, acupuncturists, and other health care providers work hard to attain professional standing. Because their knowledge is specialized and important, they may expect, and usually receive, a great deal of respect from patients. For me, the best results come when that is a two-way street.

For example, if a health care provider calls me by my first name, I take that as an invitation to call them by theirs, and do so immediately. I'm totally cool with that. But if they need to be called "Dr.," they'd better be calling me "Ms."! I am a grown woman, as worthy of respect as anyone else, especially from someone who I am paying to treat me professionally. However you define it, you have a right to be treated with respect by your health care providers!

Of course, where respect has been earned, it flows freely. I may call my doctor by a nickname in private, but in the public front office, she is "Doctor" to me!

The relationship between patient and care provider, if successful, is multi-dimensional, with aspects that can hardly be quantified. There is a chemistry to it, a mutual trust that only develops over time. I know, for example, that my chiropractor gives me her best effort. She knows I'll work hard to use her recommendations. The more I understand why something is prescribed or recommended, the more likely and able I am to comply.

A word about specialists: Sometimes it is necessary to see a health care provider with specialized knowledge, usually on a short-term basis for some acute problem. In general, your best bet is to ask your regular care provider for a referral. The better your regular provider knows you, the more likely they may be to suggest someone with whom you'll also find a rapport, but your main goal in this situation should be to address the acute problem as effectively and appropriately as possible.

In other words, you don't have to like a specialist as much as you do your regular guy or gal! However, if you're not comfortable with anyone your regular provider sends you to, for any reason, don't hesitate to let them know about it, and to ask for other suggestions if the health issue that sent you to a specialist hasn't already resolved.

The money part

Part of the reason our national health care costs have skyrocketed is that we've been lousy consumers, abrogating our choice and discretion and comparative shopping skills to insurance companies, happy to pay 20% of outrageous fees for medical goods and services.

So, part of my establishing a good rapport with a health care provider is financial. Especially for those of us toting our own health care freight, it's best to know in advance the usual cost of an office visit or annual physical. Discuss your own financial and insurance situation frankly with the provider and the business office. Some providers offer a sliding scale or discount when they understand that a giant insurance company isn't going to automatically pay 80% of your bill. It never hurts to ask.

In seeking any complementary or alternative treatment, investigate first how much, if any part of the cost, will be borne by any insurance you carry. Consumers must each do their own cost-benefit analysis of un-reimbursed CAM therapies.

If you're getting a new prescription, ask about its cost, and if it's available in a less expensive generic version. If the doctor's clinic has an on-site lab, don't assume costs will be lower than costs at a specialized laboratory elsewhere. Along the same lines, check all bills and statements for accuracy.

This is, perhaps, especially important with any hospital bills, where many billable treatment codes may be entered by many individuals. A month after my son was born, in addition to a bill for the surgeon's services, I received a bill from the hospital's resident pediatrician. However, we had arranged for a pediatrician before the baby was born (Rag Blog shout-out to Dr. Jimmy Justice and Nurse Gloria, wherever you are!), who saw our son daily while he and I lay up in Brackenridge and I tried to heal.

I called the hospital billing office to let them know I'd received their pediatrician's bill in apparent error. A nice lady explained to me that the doctor's education was very expensive, and so the parents of all babies who used the hospital nursery (for which we'd also been billed) paid for his services whether he ever saw them or not.

I replied that my education had also been expensive, but that I did not bill people for work I didn't do, and if that was their practice, they should institute legal proceedings to repossess the baby. That was the end of the matter.

Ask about what-if's as well as likely's. Once, I became established with a GP in a shared practice, who seemed very nice. I always prefer shared practices, so if I get sick and my primary care provider is unavailable, someone with ready access to my chart will be there.

Unfortunately, between the time of my initial physical exam and a scheduled follow-up visit, a family emergency forced him to resign and move away. The business office told me there would be another $80 fee to "re-establish" myself before I could see another of their physicians! For me personally, this was a deal-breaker. I would prefer to establish myself elsewhere, and not be nickle-and-dimed to death, especially when I'd seen the departing guy exactly once!

Self-Health Tip:
Use Your Brain to Protect Your Body!

In selecting a complementary and alternative medicine (CAM) product or therapy, use independent sources to learn about uses, dosage, side effects, and possible interactions with medicines, foods, or herbs you use. The American Botanical Council, a non-profit educational organization headquartered in Austin, Texas, is one such source; there are many others, including CAM professionals.

A website selling a "miracle" product isn’t the best information source! Third party verifications of good manufacturing practices, or that a product contains what the label says it does, are also available from several reputable sources.

For safety’s sake, TELL your doctor about your CAM practices. Chances are s/he didn’t learn much about them in med school, and may think CAM is useless. So how is s/he ever gonna learn differently unless you speak up?

Seriously, keeping use of herbs or supplements secret for fear of Doctor's disapproval is not only dumb but dangerous! Some DSs and many HMs have effects that can interfere with other medicines. If you want to use CAM safely in your personal health continuum, bring your health care provider in on the discussion. Share information you find useful, and listen to them with care, even if they don't always say what you want to hear.

To be responsible for our own health, we must weigh all the evidence. For me, if a health care professional won’t discuss CAM as well as conventional care, we may not get along!

Of course, one must make an exception to this disclosure rule in the 36 medical cannabis-prohibiting states, so as not to leave a paper trail for insurance companies who can cancel coverage in a heartbeat. In any event, do not use cannabis for 24 hours before any scheduled medical exam, including -- with great emphasis! -- eye exams!

Marijuana has been used to treat glaucoma since Queen Victoria’s day. A vasodilator (blood vessel relaxer), it temporarily lowers blood pressure as well as interocular pressure. If you have high "hydraulic pressure" going on anywhere, you and your physician and/or eye doctor need accurate information.

-- mgw

The Rag Blog

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Stayin' Alive : Managing Osteoarthritis with Complementary and Alternative Medicine

"Skeleton Woman." Prisma color pencil, watercolor, applique by Lucy Madeline
Stayin' Alive:
Hanging out in the joints with osteoarthritis

By Mariann G. Wizard / The Rag Blog / January 19, 2010

[Stayin' Alive is a new periodic column on Complementary and Alternative Medicine by Rag Blogger Mariann G. Wizard, a professional science writer with a wide-ranging knowledge of natural health therapies. Readers may suggest topics for future columns, within the restrictions suggested below, in the Comments section of The Rag Blog.]

Osteoarthritis (OA) is a collective name for several degenerative processes in the body’s moveable joints, most often the hips, knees, feet, shoulders, or hands/wrists/fingers. OA incidence rises with age, and after about 50, affects more women than men. It causes chronic, often intense pain, reduces flexibility and strength in affected joints, and can discourage healthy exercise.

OA has several causes, including some that are hereditary, and it takes a multi-faceted approach to prevent or slow its progress. As usual, “use it or lose it”; healthy weight-bearing exercise is the best weapon against OA! Other sensible health practices are also beneficial, e.g., lower weight helps knee, foot, and hip OA; take a load off!

Rheumatoid arthritis (RA) is a different condition, and I'm not taking it on today -- maybe in a future column!

Conventional Western or modern medicine isn’t very successful with chronic illnesses, and dissatisfaction with this lack of success helps fuel use of complementary and alternative medicine (CAM). Conventional OA care includes over-the-counter (OTC) and prescription (Rx) pain relievers, e.g., non-steroidal anti-inflammatory drugs (NSAIDs). OTC NSAIDs (e.g., aspirin, ibuprofen, naproxen sodium) relieve pain but can have serious side effects. Rx NSAIDs, such as Celebrex®, can have even worse effects; similar drugs have been withdrawn due to their dangers.

There is also a vast array of Rx pain relievers about which I know very little, except what friends with severe OA and/or RA tell me. Please do not make any changes in your Rx medications, or begin using any herbal medicines (HMs), without discussing fully with your treating physician! I'll have more to say about this later, and what, maybe, some natural therapies can offer even those who really struggle with OA.

One formerly-CAM treatment, injection of hyaluronic acid into affected joints to improve lubrication, is now widely used by mainstream physicians, though with scant evidence it helps.

Hip and knee OA, if they are too debilitating, are treated conventionally with joint replacement surgery -- much more sophisticated than it was in its early years! -- and everyone I know personally who’s had this surgery has been pleased with the results. My Mom had both knees replaced after being diagnosed with cancer; it greatly improved her remaining five years. However, all surgery has risks. Also, today's replacements have an expected lifetime of only 15-20 years, so it makes sense to postpone replacement as long as possible, and not have to do it again later!

I have OA, starting in a broken toe in 1970 ("my weather toe") and spreading to knees (too much rock'n'roll), wrists and hands (too much keyboard) over time. I used OTC pain relievers for years, but became concerned because of potential stomach and/or liver damage from sustained use.

I then used an Rx pain reliever, with near-disastrous results. Since then, I've been exploring CAM's OA options personally, as well as continuing to read and report on the science behind them. I want to use OA here to show the breadth of CAM treatments for one very common condition, and some of their strengths and weaknesses, as an overall introduction to CAM.

If you've read my column before, you may recall my definition of CAM, but here it is again:

CAM is all health practices developed over the course of human history, everywhere in the world, before the discovery of microbes, and many developed since then outside of “Western” medical practice.

Prevention and treatment: Dietary supplements

Dietary supplements (DSs) can help maintain healthy levels of vitamins, minerals, amino acids, and other compounds in the body. I'll write more about nutrition, the modern food supply, and DSs in the future. For right now, it's enough to know that I consider HMs as very specialized DSs, and will talk about them separately. Unless otherwise noted, DSs, taken as recommended, shouldn't interfere with Rx or OTC medications or other conventional therapies. Over time, they may reduce the need for pain relievers, or slow the progress of disease.

Glucosamine and chondroitin, together and separately, have the most evidence for preserving and perhaps increasing cartilage in joints, the “padding” that keeps bone from rubbing on bone. Cartilage is invisible in X-rays, but OA is diagnosed by the decrease in inter-joint (articular) space as cartilage is lost to wear and tear, and to aging.

Inter-joint space in my knees increased when, after arthroscopic surgery for a torn cartilage in one of them in 1997, I began using both glucosamine and chondroitin, and has held steady ever since. I have much less pain, less often, and more flexibility in my knees than I did before starting them, and no serious problems with other joints. Both compounds have good safety records.

Glucosamine is essential for joint lubrication. It is found in all living things. Chondroitin is a related compound. Neither occurs in the usual human diet. Supplements are made from shellfish exoskeletons, and should be avoided by anyone with shellfish allergies. It takes several months to begin to notice the benefit, and you have to keep taking the supplements; for me, it's worth it!

S-adenosylmethionine (SAM-e), a natural compound produced by all organisms, decreases with age. SAM-e helps maintain joint health. It's also used for mood support and healthy liver activity. Methylsulfonylmethane (MSM) works with SAM-e and glucosamine for healthy cartilage. MSM is found in meats, fruits, and vegetables, but we metabolize it less efficiently with age, making supplementation desirable.

Essential fatty acid (EFA) intake is vital for joint lubrication and much more. Omega-3 and omega-6 EFAs (found, e.g., in hempseed oil, flaxseed oil, algae, and fish oil) must be obtained from diet, the body can’t produce them. Chances are excellent you don't eat enough EFAs. Supplementation can be recommended for almost anyone, it has so many benefits. It may cause temporary bowel looseness, but overall, improves regularity.

Osteoporosis contributes to OA through bone loss in joints. While elderly women are especially at risk, men and young women are not exempt. Bone health is complex, but everyone needs calcium and vitamin D to maintain strong bones. Supplements for menopausal women often have other bone-nourishing components, such as plant estrogen isoflavones from soy, red clover, kudzu, or other legumes.

Phytoestrogen use by women with elevated risk of estrogen-sensitive cancer is controversial, and probably best avoided. Also, phytoestrogens may interact with Rx medicines; I simply don't know enough about all the synthetic drugs out there to feel comfortable saying phytoestrogen use is OK for everyone! I will say that bone-conserving pharmaceutical products marketed in recent years have some of the scariest potential side effects of any drugs advertised on teevee; far better to keep your bones strong; again with good basic nutrition, weight-bearing exercise, and, if needed, DSs.

BTW, the preferred form of calcium these days seems to be calcium citrate, absorbable in the human digestive tract. Apparently, the ground-up oyster shell tablets I sucked down for years don't do much good; that calcium isn't in a form our bodies can use!

Treatment: Pain relief

Many CAM treatments for pain have strong evidence of benefit. Massage; aromatherapy; warm-to-hot therapeutic compresses, baths or showers; yoga; and meditation all may be used to good effect. Pepper salves are effective “counter-irritants”; that is, they produce such an intense burning sensation that joint pain becomes irrelevant! (This isn’t as awful as it sounds; OA pain may worsen in cold weather, and is often felt as a cold ache and stiffness, with pain on movement. Heat can feel wonderful, relaxing muscles and boosting blood circulation.)

OTC “heat” products use the same principle, as does the traditional Chinese salve Tiger Balm®. However, effectiveness of counter-irritants is generally short-term. One friend who has severe arthritis used a "TENS" device successfully -- delivering rapid, minute electrical shocks to himself -- for a while. Acupuncture also helped him temporarily, but it, too, is more suited, in my opinion, to relief of acute pain rather than chronic.

For those who prefer HMs, cat’s claw has thousands of years of human use for OA in South America, but has been little studied. It is not an NSAID; its means of action is not understood. I have personally used cat’s claw -- with the DSs mentioned above! -- for my OA, and find it to be one of the faster-acting herbs. If I miss taking it for a few days, my right thumb reminds me; after a few days of resuming use, I no longer notice my OA. It seems to be very safe, with no side effects except, perhaps, some bowel looseness; it goes away.

Cat’s claw isn't very expensive; however, there are concerns about sustainability due to increasing demand. The root bark is used; not a very sustainable harvesting method. I wonder if it would grow in Texas? Cat's claw hasn't been studied in conjunction with Rx or OTC pain medications, and again, I would hesitate to recommend an HM to anyone using such products. I started using cat's claw after a severe allergic reaction to a prescribed NSAID left me unable to use any NSAID, even aspirin; this was about the same time the above-mentioned thumb first began flaring with OA pain.

In general, if an HM is effective, it has the possibility of interacting with other medicines. If you think herbs are "safe" because they are "natural"; please, get a clue! Many perfectly "natural" substances can kill you deader than a dodo! Over 90% of existing synthetic pharmaceutical drugs are based on individual, "active" plant molecules from HMs.

Another HM pain remedy now legal for residents of 14 states, but not yet under the Lone Star, is Cannabis sativa, sweet Mary Jane. In British and U.S. studies of intractable chronic nerve pain -- pain unrelieved except by massive doses of morphine -- and multiple sclerosis (MS), ganja allowed patients to separate themselves mentally from their pain for a while.

Senseless continued prohibition of this valuable HM will soon be challenged by the pharmaceutical companies' desire to cash in on the “pot of gold." Bayer Health, for example, has an investigational new drug (IND) permit in the U.S. for Sativex®, a whole-cannabis extract in a mucosal spray, from British GW Pharmaceuticals. Sativex is already approved in England and Canada for MS.

An IND is a first step in approval for U.S. Rx drugs. If a whole-herb extract is permitted nationally, patients outside medical marijuana states will have a powerful argument for their use of the actual whole herb. Marijuana hasn't been clinically studied in OA, but is widely used for symptomatic relief.

Now, to be perfectly clear, I'm talking about ingesting marijuana! I've heard of using cannabis topically, in hot water compresses, but hey, what a waste! Tetrahydrocannabinol (THC), the main active ingredient in marijuana, isn't soluble in water, but in fats and oils. So, there's no evident way a hot water weed compress would bring any more relief than that obtainable less expensively from a wet towel. I expect somebody will tell me they've used the spent vegetable matter from making "electric butter" as a pain compress with fabulous results; maybe so, but did they also eat the brownies?

If you have surgery -- for any reason, not only joint replacement -- stop using all HMs and DSs (except any you and your doctors agree on) two or three weeks in advance. Some can interfere with blood clotting, effects of anesthesia, and/or post-surgical pain meds.

Other measures

OA is one of the most widespread chronic diseases in the world, and I’ve only scratched the surface of CAMs available. Purely dietary measures, such as eating only anti-inflammatory foods, can be very useful. For example, if you're an adult, stop drinking animal milk! Cheese, yogurt, kefir, etc., are all better for you.

There are many anti-inflammatory HMs with laboratory evidence, CAM usage, and not enough human clinical trials. Trace elements? People with higher intake of dietary boron seldom have arthritis. Shark cartilage, as a DS, is being tested for its effects by the U.S. National Institutes of Health (NIH), one of only a small number of DSs the NIH found had enough preliminary clinical evidence to qualify for government-funded study. Hundreds of Chinese, Indian, and African traditional OA CAMs are used with apparent success, especially by patients from corresponding backgrounds.

Some widely-promoted OA "cures" have been pretty well discredited, among them dimethyl sulfoxide (DMSO), a commercial solvent that penetrates the skin readily and is used as a carrier vehicle for a few human and veterinary medicines. Unfortunately, claims of arthritis relief from DMSO may have been due to the undisclosed inclusion of other pain relievers; also, animal studies found that DMSO use damages the eye lens.

DMSO cannot, however, be described as either a conventional or CAM therapy; it was a scam, pure and simple, because arthritis is a pain, and conventional medicine offers only limited "management" options and no cure. DMSO had no record of thousands of years of human use; no documentation by any reliable source; was not a plant-derived molecule. But many thousands of people tried it because they felt they had nothing to lose.

If you’re too young and healthy to have OA, you’re not too young to prevent it! Healthy weight, basic dietary intake, weight-bearing exercise, and mindfulness are your first lines of defense. Mindfulness includes, for example, being careful about surfaces for running, dancing, and other high-impact activities (firm but resilient is best), making sure you have good arch and ankle support in your shoes, and generally giving your joints a little support so they can support you later in life. Abused joints are weak points OA is likely to attack.

Walking can help prevent hip and knee OA, and benefit OA sufferers as well. I use musical weighted Chinese exercise balls to keep my hands and fingers limber. Whatever you do, keep moving!

Next time: Choosing a health care provider.

Previously: Stayin' Alive: Towards a conscious self-health-care continuum.

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Stayin' Alive : Complementary and Alternative Medicine

"Tree of Life," working design for Stoclet Frieze, Gustav Klimt, 1905/09.
Stayin' Alive:
Towards a conscious self-health-care continuum

No system of medicine is static, and none has a monopoly on beneficial knowledge or tactics.

By Mariann G. Wizard / The Rag Blog / January 4, 2010

[Introducing a new periodic column by Rag Blogger Mariann G. Wizard, a professional science writer with a wide-ranging knowledge of natural health therapies. Readers may suggest topics for future columns, within the restrictions suggested below, in the Comments section of The Rag Blog.]

“Complementary and alternative medicine” (CAM), in the U.S. and several other nations, refers to health practices that are not currently part of “mainstream” or “conventional” medicine. This flexible definition allows for therapies that accumulate enough scientific evidence -- or generate enough patient demand! -- to become part of mainstream practices.

In the US, for example, chiropractic, once the domain of energetic and sometimes kooky "bone crackers,” has benefited from the experience of practitioners, the development of comprehensive theory and standards of care, and the establishment of accredited colleges, and is now paid for by most insurance plans -- the true test of a treatment’s acceptance! Acupuncture, as well, with demonstrable benefits in pain relief at minimum, has gained mainstream acceptability in the U.S. within very recent memory.

However, the current CAM definition is rather misleading, having been imposed by conventionally-trained and -biased authorities. It is more accurate to think of CAM as all health practices developed over the course of human history, everywhere in the world, before the discovery of microbes, and including many health practices developed since then outside of “Western” medical facilities.

CAM includes, for example, entire multi-modal systems of medicine, such as traditional Tibetan medicine, Ayurveda, naturopathy, and others, some with continuous documentation of use and development over thousands of years. It also includes more recent practices: e.g., aromatherapy, Reiki, and Essiac, each with its own ancient roots.

One difference between most CAM therapies and “conventional” medicine, often cited by CAM skeptics, is a frequent lack of scientific evidence for CAMs, or even “disproof” of their worth. These criticisms are worth a closer look. “Scientific evidence” is not always best acquired in a laboratory setting, and what works in rats doesn’t always have the same effects in people.

Studies are often designed, depending on funding sources, to demonstrate certain hypotheses; their design may not be fair to competitors. Media coverage tends to focus on negative results in science reporting, as it does in other news. For example, a number of studies have found the herb St. John’s wort as effective as prescription drugs in treating mild to moderate depression. However, the most media coverage occurred when the herb was found to be not-so-helpful for serious depression. No one had ever claimed it would be.

So-called “anecdotal evidence” of practitioners and patients provides support for many CAM modalities, and is often discounted by those who understand only randomized, double-blinded, placebo-controlled clinical trials. However, lack of clinical studies is another misleading negative. Such studies are most often funded by pharmaceutical companies, and are extremely costly. Unless a unique, patentable, reproducible compound has been isolated for testing, there is little incentive to fund research on common herbal remedies such as echinacea, ginger, and aloe vera, or even more novel dietary supplements like shark cartilage.

Acupuncture. Image from Phiya Kushi's Blog.
For some therapies, problems in adequate blinding or other study design factors present substantial obstacles to randomized testing. Acupuncture, for example, is difficult to administer in placebo form. Cannabis medications also present problems in blinding, since experienced cannabis users have no difficulty in distinguishing the real thing from placebo no matter how it is administered; the effects speak for themselves. Different study designs often make it difficult to compare “apples-to-apples” -- but this is as true with pharmaceutical drugs as well as with herbal compounds!

Nevertheless, credible research is being done around the world every day on CAMs. For over 10 years, I have reviewed peer-reviewed journal reports of such work for the American Botanical Council’s HerbClips®, and have reported occasionally for ABC’s peer reviewed journal, HerbalGram®, on regulatory and other matters.

During that time, I’ve also -- somehow -- gotten older, and have begun to experience some of the annoying pitfalls of that process, as well as of ordinary hard knocks and exposure to modern living. While I began my work with ABC without any particular prejudice for or against conventional medicine or CAMs, today, I believe that each has its uses, and its distinct limitations.

I haven't accepted medical or other advice to “get used to” chronic pain and increasing disability any more than I’ve accepted war, injustice, disharmony, or exploitation. These may all be losing battles in the long run, but what are we doing that’s any more important?

A year or so ago on a rainy day, a homeless guy at the downtown library asked me why so many -- pardon the expression, "older ladies in Austin" -- were sporting, as I was, a knee or elbow athletic brace. I stopped and thought about it for a minute. "Because," I finally said, "we are fighting death to the finish!"

No system of medicine is static, and none has a monopoly on beneficial knowledge or tactics. ABC’s knowledge base -- including my own work -- has been priceless in helping me assess CAM options for my use, and even for friends and family facing health concerns. Like a growing world majority, I now consciously combine CAM practices with conventional medical care in a personal health continuum, making the decisions that affect, literally, my life, for myself, like we used to say in Students for a Democratic Society. I consider myself a “health independent” in the same sense that some voters claim independence from major political parties!

The fact is that conventional medicine is very poor in its ability to treat chronic illnesses, and most CAMs are ineffective or unnecessarily slow in treating acute illnesses such as infections. The fact is that professional health care providers of any kind are becoming less accessible to many of us, and that the costs of health care seemed doomed to skyrocket. The smart thing to do, it seems to me, is to use whatever we can to stay healthy!

Meanwhile, there is a skill to assessing unfamiliar health practices, products, and practitioners that I believe can be applied whether these are “conventional” or CAM-related, and I propose to try to impart some of that skill to readers of The Rag Blog.

If you have questions or suggested topics related to natural health practices, please post them in the Comments section of this article! For the record, I will NOT attempt to diagnose any symptoms, diseases, or medical problems. I will NOT recommend specific products, practices, or practitioners, except as examples of alternatives to be considered. I will NOT answer any questions of an intimate nature, e.g., what to do if you have an erection lasting longer than four hours! If none of you slackers have any interesting questions, I will merely regale you with my own adventures in health care; Lord'a'mercy; we are getting old!

I WILL freely discuss health-protective measures such as diet, exercise, and stress relief. I WILL consult with and drag in health care practitioners, researchers, and patients of all kinds as needed, some of whom may let me quote them. I MAY prescribe familiarity with controversial theories, regulatory policies, and historical tirades; take as directed: always with a grain of salt. Your life and health are your most valuable possessions -- guard them well!

Next week: “Osteoarthritis: it takes a village.”

"Bee's Knees," by tyrone_31 / photobucket.

Prevention tip of the week:
Save your knees now!

Everybody should do this mild exercise several times a week if at all possible! Especially if you have weak knees, or “bad knees run in the family," if you’ve had any kind of knee surgery short of a replacement, or if you do any running or jumping, this is a great way to strengthen and protect the most complex joint in your body.

1. Lie flat on your back on the floor, with feet more or less in line with your shoulders.
2. Extend your arms comfortably from your shoulders, so that, seen from the ceiling, you make a sort of “t” shape.
3. Pull your knees up and your feet towards your buttocks as far as you comfortably can, keeping your feet slightly separated and your feet flat on the floor. Seen from the side, you look a little like this: _/\__o
4. Keeping your upper body flat on the floor, gently lower both bent knees as far as you comfortably can to the right side of your body. Your left hip will lift off the floor. Seen from the ceiling, your knees look like a double chevron: >>. Stretch a little tiny bit closer to the floor with both knees, and hold for 20 seconds.
5. Return to position 3 and reverse, lowering knees to the left side: <<. Stretch and hold.
6. Repeat twice, three times a week, for six months. If you feel the improvement, KEEP DOING IT AS LONG AS YOU CAN GET DOWN ON THE FLOOR AND GET UP AGAIN! Don't do it in bed or lying on the couch; you may throw your back out, and I don't want you blaming me for your sciatica!

Hint: If your low-side knee doesn’t go all the way flat to the floor, or the high-side knee doesn't go parallel to the floor when you stretch to left or right, well, that is a goal you can set. Gently stretch as far as you can without discomfort; and next time go a millimeter further!

This stretch, unlike the bicycling motion often used in post-surgical knee rehab, strengthens muscles and ligaments along both sides of the kneecap that help keep the joint stable -- if you’ve ever felt the sickening sideways lurch of thigh-bone or leg-bone pulling away from knee-bone, you know the importance of these supportive structures!

Thanks for this tip to Wendee Whitehead, Doctor of Chiropractic, Austin, Texas, whose exact words to me were, “Knees are totally fixable!” Keep yours strong and flexible with this simple, zero-impact move.

--mgw

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American Health Care : Monster Run Amok

Cartoon by RS Janes / LTSaloon.
Once the envy of the world...
The American health care disgrace

By Dr. Stephen R. Keister / The Rag Blog / November 7, 2009

Between 1910 and 1970 American medicine was the envy of the world. The giants of American culture were its physicians: William Osler. Howard Kelly, Harvey Cushing, Elliott Joslin, Charles and Will Mayo, W.W.G. Maclachlan, Jonas Salk, Alfred Sabin, to name a few. Mothers dreamed of their sons growing up to be physicians, who were considered on a par with clerics, or college professors.

From the 1970s on, many physicians ceased to be idealists who took care of the ill, regardless of ability to pay, and became content to make a decent living without idealizing money. Things have indeed changed. The physicians’ respect in the community has diminished to a point that is akin to that of the MBA, used-car salesman, or fundamentalist preacher. (My apologies to the used car salesman as I have several very honest, upright acquaintances in that area of business.)

The average American -- except those who are very well-to-do and count doctors among their golfing buddies -- think of medical care in terms of CT Scans, MRI machines, laboratories, and medical device purveyors. No longer, to most folks, is the doctor a friend and confidant.

With this surrender to the for-profit insurance industry the once proud, idealistic physician has morphed into the "provider,” paid and manipulated by the insurance executives. Happily, the current health care debate suggests that many idealistic physicians have survived -- as evidenced by the 60%-plus support among doctors for a government provided alternative to the insurance cartel's monopolistic rationing and manipulation of health care. My gratitude to Physicians for a National health Care Program and The American College of Physicians, with their thousands of dedicated members.

Currently the system of medical care in the United States is a blot on our international reputation. Most of those living in Western Europe, and many in the Third World, are baffled about how this great nation could countenance having 50 million individuals without regular medical care. And they wonder how we could allow 45,000 persons to die yearly for lack of insurance (according to a report from the American Journal of Public Health), and how we could have let 17,000 children die over the past two decades (according to a study released by the Johns Hopkins Children's Center).

They are confused why the richest country in the world needs to import physicians from the Third World to make up for the inadequacy of trained American physicians. (My thanks to the numerous very capable physicians from India that I have encountered, as well as many from Iran and other Middle Eastern nations.) Nowhere else in the world, save in the USA, do we see signs posted in malls announcing a spaghetti dinner at a fire house to help defray the costs of a child's brain tumor surgery.

And take this mind-boggling piece of information: according to The World Health Organization, only one of thirty companies producing H1N1 flue vaccine is based in the United States, that being Aviron/Wyeth/Lederle, which makes a nasal vaccine. Our main supplier is the U.S. branch of Sanofi Pasteur, a French company located in this country, Nearly all European nations have one or more companies producing the vaccine; Korea has three and China seven. When I retired in 1990 I recall that three U.S.-based companies were making influenza vaccine. I have been told that production was discontinued because of excessive unused inventory of the vaccine, which is dated, which diminished the profits of the manufacturer.

There are still many excellent if harried physicians remaining in the United States; however, getting into a physicians office on short notice has become a problem for most people. I am aware of a friend with a torn knee cartilage who was told that it would take six weeks to get an appointment with an orthopedic surgeon, while another older lady with digestive problems had to wait six weeks to have an esophagoscopy scheduled.

A third elderly acquaintance, with interstitial cystitis, has seen a urologist on three occasions, totaling approximately 20 minutes, was never examined, and on each occasion was prescribed antibiotics purely on the basis of a questionable, voided urine culture. Never did she receive an explanation of her condition, or its long term implications, or was cystoscopy suggested. I finally accessed her literature relative to the condition from the Mayo Clinic via Google.

Where I live, obtaining an appointment with a dermatologist may well take several months. Yet, the opponents of decent health care in the United States continue to spread the myth that ours is "the best system in the world" and that in other nations you can expect long waits to get an appointment -- which is most likely to be true only if you are seeking a specific physician at a major institution. Currently the U.S. Chamber of Commerce is in the forefront of the lies and deceit industry, joining the Health Insurance industry in promulgating ad after ad on television, and a large percentage of the unsophisticated American public tends to confuse this promotional material with factual information.

Last Thursday, Nov. 5, we saw a well choreographed demonstration in Washington, with thousands of the uninformed and misinformed brought in on busses and provided with placards which they frequently did not understand, and all this was paid for by institutions associated with the health insurance industry. In addition the mainstream TV programs continue to provide panels of talking heads to discuss health care, most of them provided by the conservative think tanks.

The other clever maneuver of the insurance industry is to incite the anti-abortion lobby and get them aligned against decent health care. These folks, who are interested primarily in ovocysts, and not in children once born, rail against decent health care as if the whole plan was devised as a scheme to provide abortions for the poor -- when the Hyde Amendment already makes it illegal to use federal funds to provide abortions. The opponents of decent care for all Americans are stooping to any ruse or deceit, as evidenced by the ads espousing Medicare Advantage as "good health care,” to influence the ill informed, culpable American public.

I write this on the eve of the intended House of Representatives vote on a bill for health care for all. Of course, we would hope that such bill would include the core features outlined by Health Care for America Now:

1. A public health insurance option for all established by the federal government,
2. One that is available to individuals and employers across the nation,
3. Not merely a panel of private plans (such as FEHBP, the health insurance available to federal employees), and not limited to low income individuals,
4. A government body, or independent entity established by government, sets policies and bears the risk for paying medical claims,
5. May hire insurance companies, where efficient and appropriate, to handle administrative functions such as paying claims,
6. Provides broad access to providers that meet defined participation standards,
7. Consults with providers and nonpartisan experts to establish provider rates and develop and implement payment system reforms that promote quality care, prevention, and good management for chronic care,
8. Operates separately from existing public programs such as Medicare, but may tap into their infrastructure (e.g. payment systems, claims processing, and appeals processes).

Further details cam be found here.

The next step, of course, is to try to inject some reason into the discussion in the Senate which appears at times to have abandoned any sense of logic. Take, for instance, the bizarre, suggestion that health care reform include coverage for "prayer treatment." Odd that we in the United States will even suggest the commercialization of prayer! Next, maybe we should claim airfare to Lourdes as a "medical expense" when we file our income tax deductions.

But, seriously, we keep hearing from Harry Reid that it will be difficult to get the 60 votes to pass a decent health care bill. This is undoubtedly true, if the Senate lies down and acts like a whipped dog. There is a solution under parliamentary rules and it’s called the “nuclear option.” Change to Senate Rules is discussed in detail on Wikipedia.

The key part reads as follows:

The nuclear option is used in response to a filibuster or other dilatory tactic. A senator makes a point of order calling for an immediate vote on the measure before the body, outlining what circumstances allow for this. The presiding officer of the Senate, usually the Vice President of the United States or the president pro tempore, makes a parliamentary ruling upholding the senator/s point of order. The Constitution is cited at this point, since otherwise the presiding officer is bound by precedent. A supporter of the filibuster may challenge the ruling by asking, "Is the decision of the Chair to stand as the judgment of the Senate?" This is referred to as "appealing to the Chair." An opponent of the filibuster will then move to table the appeal. As tabling is non-debatable, a vote is held immediately.

A simple majority decides the issue. If the appeal is successfully tabled, then the presiding officer's ruling that the filibuster is unconstitutional is thereby upheld. Thus a simple majority is able to cut off debate, and the Senate moves to vote on the substantive issue under consideration. The effect of the nuclear option is not limited to the single question under consideration as it would be in a cloture vote. Rather, the nuclear option effects a change in the operational rules of the Senate, so that the filibuster or dilatory tactic would therefore be barred by the new precedent.

The proponents of decent healthcare-for-all face the Rubicon. We the public must exert enough pressure on our elected representatives, and upon President Obama, to offset the chicanery in the House and Senate, and to try with reason and compassion to counter the bribing of our elected officials, and the misinformation and outright lies deluging the public. Time is short, but this old man would like to finish his later days with head high, once again seeing our country as a leader in health care.

We would like to see our nation respected as a leader in ethics and morality, rather than being looked upon as a Third World nation when it comes to treating the sick and disadvantaged. Ours should be a nation based on doing what is correct and not one subservient to the fringe manipulated by the big corporations, the financial elite, and those who allow their ambition to overcome our traditions of kindness and charity as expressed in the Sermon on the Mount and the Beatitudes.

Dr. Richard Wolff, economist at The University of Massachusetts, says that our economic collapse -- which has gradually developed over the past 150 years and has accelerated since 1970 with wage stagnation, and excessive profits -- may take years to correct, if it can be corrected at all. But let us show the humanity, the sense of community, that we see in the Western European nations. Their epiphany occurred after World War II, when they moved beyond the devotion to self interest, to accumulated wealth at all costs, that is inherent in the doctrine of "private enterprise" and neoliberal economics.

Perhaps those folks who keep pretending that this is a “Christian Nation" should review the true meaning of their alleged faith. Perhaps it is time to cast out the money changers and show some compassion for our fellow man. Remember what Lyof Tolstoy wrote in 1893 in The Kingdom of God Is Within You:

The Christian churches and Christianity have nothing in common save name: they are hostile opposites. The churches are arrogance, violence, ursurpation, rigidity, death; Christianity is humility, penitence, submissiveness, progress, life.

Let good Americans stand for life and good health.

[Dr. Stephen R. Keister lives in Erie, Pennsylvania. He is a retired physician who is active in health care reform. His writing appears regularly on The Rag Blog.]

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Health Insurance : Does Baucus Bill Make Things Worse?

Cartoon by David Horsey / Seattle P.I.
Public option a necessity:
Baucus Bill protects insurance companies

By Ted McLaughlin / The Rag Blog / October 19, 2009

There are two especially devious ways that private health insurers use to keep their own profits high (and deny health care to consumers). The first is to cherry pick only healthy people to cover with insurance, and deny insurance to sick people or people with pre-existing conditions.

The second is to deny coverage for specific treatments to those with insurance. It is not uncommon for seriously ill people to find that their private insurance will not cover the treatment they need to get well. In many cases, these people die because they are unable to get the treatment their insurance company has refused to pay for.

The Baucus Bill, the health care reform bill approved by the Senate Finance Committee, would take care of the first problem. Private insurance companies would no longer be able to deny coverage to sick people or those with pre-existing conditions (or price that coverage out of the consumer's reach). But it does nothing to fix the second problem.

In fact, an excellent article by Lisa Girion in the Los Angeles Times makes the point that the Baucus Bill would only make the second problem worse, and leave consumers no better off than they are now. After all, what good is private insurance coverage if that coverage will not pay for needed treatment?

Since they could not exclude sick people or those with pre-existing conditions, the insurance companies would be left with two choices to maintain their exorbitantly high profits -- raise premiums or deny treatment. Of the two choices, the easiest option is to deny treatment -- a choice that could easily be hidden in the policy's fine print.

Considering the fact that private insurers already do this for many expensive procedures, is there any doubt that they would protect their profits by denying coverage even more often? I think that answer is self-evident. But there is a simple solution to this problem.

One might think the solution is to require coverage and payment of any treatment declared necessary by a doctor, but that won't work. That would just raise the premium cost of private insurance, and in the Baucus Bill there is nothing by private insurance.

The real solution is to include a public option for insurance in the bill. A public option would cover those with pre-existing conditions, cover all necessary treatments and it would keep premium costs low (by significantly lowering overhead among other things). This would force the private insurers to do the same, or lose consumers to the public option.

Senator John D. Rockefeller (D-W. Virginia) says, "We've seen all the insurance industry tricks -- hiding rules in fine print, cutting people off when they get sick, and refusing to pay for necessary treatment because of pre-existing conditions. This is why I am fighting for a public option -- we need an insurance option out there that puts people first, not profits. We need a real public option, one that competes with private insurance companies to keep them honest and accountable."

There are those who think the public option would drive private insurers out of the health insurance business. Personally, I don't care. There are plenty of other things they can insure.

It comes down to a choice. Which is more important -- protecting private insurers or providing necessary treatment for sick Americans? I choose the latter.

[Rag Blog contributor Ted McLaughlin also posts at jobsanger.]

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Michael Pollan: What's Really Wrong with Health Care in America - Corporate Agribusiness

Big Food vs. Big Insurance
By Michael Pollan / September 9, 2009

TO listen to President Obama’s speech on Wednesday night, or to just about anyone else in the health care debate, you would think that the biggest problem with health care in America is the system itself — perverse incentives, inefficiencies, unnecessary tests and procedures, lack of competition, and greed.

No one disputes that the $2.3 trillion we devote to the health care industry is often spent unwisely, but the fact that the United States spends twice as much per person as most European countries on health care can be substantially explained, as a study released last month says, by our being fatter. Even the most efficient health care system that the administration could hope to devise would still confront a rising tide of chronic disease linked to diet.

That’s why our success in bringing health care costs under control ultimately depends on whether Washington can summon the political will to take on and reform a second, even more powerful industry: the food industry.

According to the Centers for Disease Control and Prevention, three-quarters of health care spending now goes to treat “preventable chronic diseases.” Not all of these diseases are linked to diet — there’s smoking, for instance — but many, if not most, of them are.

We’re spending $147 billion to treat obesity, $116 billion to treat diabetes, and hundreds of billions more to treat cardiovascular disease and the many types of cancer that have been linked to the so-called Western diet. One recent study estimated that 30 percent of the increase in health care spending over the past 20 years could be attributed to the soaring rate of obesity, a condition that now accounts for nearly a tenth of all spending on health care.

The American way of eating has become the elephant in the room in the debate over health care. The president has made a few notable allusions to it, and, by planting her vegetable garden on the South Lawn, Michelle Obama has tried to focus our attention on it. Just last month, Mr. Obama talked about putting a farmers’ market in front of the White House, and building new distribution networks to connect local farmers to public schools so that student lunches might offer more fresh produce and fewer Tater Tots. He’s even floated the idea of taxing soda.

But so far, food system reform has not figured in the national conversation about health care reform. And so the government is poised to go on encouraging America’s fast-food diet with its farm policies even as it takes on added responsibilities for covering the medical costs of that diet. To put it more bluntly, the government is putting itself in the uncomfortable position of subsidizing both the costs of treating Type 2 diabetes and the consumption of high-fructose corn syrup.

Why the disconnect? Probably because reforming the food system is politically even more difficult than reforming the health care system. At least in the health care battle, the administration can count some powerful corporate interests on its side — like the large segment of the Fortune 500 that has concluded the current system is unsustainable.

That is hardly the case when it comes to challenging agribusiness. Cheap food is going to be popular as long as the social and environmental costs of that food are charged to the future. There’s lots of money to be made selling fast food and then treating the diseases that fast food causes. One of the leading products of the American food industry has become patients for the American health care industry.

The market for prescription drugs and medical devices to manage Type 2 diabetes, which the Centers for Disease Control estimates will afflict one in three Americans born after 2000, is one of the brighter spots in the American economy. As things stand, the health care industry finds it more profitable to treat chronic diseases than to prevent them. There’s more money in amputating the limbs of diabetics than in counseling them on diet and exercise.

As for the insurers, you would think preventing chronic diseases would be good business, but, at least under the current rules, it’s much better business simply to keep patients at risk for chronic disease out of your pool of customers, whether through lifetime caps on coverage or rules against pre-existing conditions or by figuring out ways to toss patients overboard when they become ill.

But these rules may well be about to change — and, when it comes to reforming the American diet and food system, that step alone could be a game changer. Even under the weaker versions of health care reform now on offer, health insurers would be required to take everyone at the same rates, provide a standard level of coverage and keep people on their rolls regardless of their health. Terms like “pre-existing conditions” and “underwriting” would vanish from the health insurance rulebook — and, when they do, the relationship between the health insurance industry and the food industry will undergo a sea change.

The moment these new rules take effect, health insurance companies will promptly discover they have a powerful interest in reducing rates of obesity and chronic diseases linked to diet. A patient with Type 2 diabetes incurs additional health care costs of more than $6,600 a year; over a lifetime, that can come to more than $400,000. Insurers will quickly figure out that every case of Type 2 diabetes they can prevent adds $400,000 to their bottom line. Suddenly, every can of soda or Happy Meal or chicken nugget on a school lunch menu will look like a threat to future profits.

When health insurers can no longer evade much of the cost of treating the collateral damage of the American diet, the movement to reform the food system — everything from farm policy to food marketing and school lunches — will acquire a powerful and wealthy ally, something it hasn’t really ever had before.

AGRIBUSINESS dominates the agriculture committees of Congress, and has swatted away most efforts at reform. But what happens when the health insurance industry realizes that our system of farm subsidies makes junk food cheap, and fresh produce dear, and thus contributes to obesity and Type 2 diabetes? It will promptly get involved in the fight over the farm bill — which is to say, the industry will begin buying seats on those agriculture committees and demanding that the next bill be written with the interests of the public health more firmly in mind.

In the same way much of the health insurance industry threw its weight behind the campaign against smoking, we can expect it to support, and perhaps even help pay for, public education efforts like New York City’s bold new ad campaign against drinking soda. At the moment, a federal campaign to discourage the consumption of sweetened soft drinks is a political nonstarter, but few things could do more to slow the rise of Type 2 diabetes among adolescents than to reduce their soda consumption, which represents 15 percent of their caloric intake.

That’s why it’s easy to imagine the industry throwing its weight behind a soda tax. School lunch reform would become its cause, too, and in time the industry would come to see that the development of regional food systems, which make fresh produce more available and reduce dependence on heavily processed food from far away, could help prevent chronic disease and reduce their costs.

Recently a team of designers from M.I.T. and Columbia was asked by the foundation of the insurer UnitedHealthcare to develop an innovative systems approach to tackling childhood obesity in America. Their conclusion surprised the designers as much as their sponsor: they determined that promoting the concept of a “foodshed” — a diversified, regional food economy — could be the key to improving the American diet.

All of which suggests that passing a health care reform bill, no matter how ambitious, is only the first step in solving our health care crisis. To keep from bankrupting ourselves, we will then have to get to work on improving our health — which means going to work on the American way of eating.

But even if we get a health care bill that does little more than require insurers to cover everyone on the same basis, it could put us on that course.

For it will force the industry, and the government, to take a good hard look at the elephant in the room and galvanize a movement to slim it down.

[Michael Pollan, a contributing writer for The Times Magazine and a professor of journalism at the University of California, Berkeley, is the author of “In Defense of Food: An Eater’s Manifesto.”]

Source / New York Times

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Meditation Helps Veterans with PTSD

Dr. David Kearney, standing, a veterans-hospital physician, conducts a mindfulness-based stress-reduction class that uses meditation and yoga techniques to combat chronic pain, depression, anxiety and post-traumatic stress disorder. In front is Stephen Brakus. Photo: Courtney Blethen, Seattle Times.
Seattle hospital teaches meditation to troubled vets
By Michelle Ma / May 17, 2009

The Seattle veterans hospital is teaching patients a form of meditation to ease their post-traumatic stress disorder. The technique called mindfulness-based stress reduction helps patients deal with anxiety, chronic pain and other health issues.

After four combat tours — two in Iraq and two in Afghanistan — normal life seemed impossible for one Seattle Army veteran.

His heart raced when driving under an overpass, and he had trouble breathing when stuck in snarled traffic. As a soldier in combat, he wouldn't dare slow down for fear of being bombed or shot.

Crowded rooms were just as bad. He locked himself away at home and drank instead of facing large groups or loud, sudden noises. He responded to the slightest sense of threat with all-out aggression.

Last summer, the 34-year-old sergeant sought help at the Seattle veterans hospital, enrolling in group and individual therapy and starting medication to treat what doctors diagnosed as post-traumatic stress disorder (PTSD).

He also practices a form of meditation he learned through the VA Puget Sound Health Care System that has eased the horrific memories that bombarded his mind.

The technique, called mindfulness-based stress reduction, seeks to help patients deal with anxiety, chronic pain and other health issues through meditation, yoga and deep-breathing exercises.

"It's like the thoughts lost their hook," the Seattle veteran said. "Before, they were just ripping me. With mindfulness, it opens up the blinders, and you realize (those thoughts) are not the totality of your existence forever."

He asked not to be named because he's looking for a job and worries employers won't hire him if they know about his PTSD.

Dr. David Kearney, a veterans-hospital physician and associate professor at the University of Washington, has offered veterans the eight-week course in mindfulness-based stress reduction for more than a year.

Kearney is running the first study of its kind to determine whether the course is effective in treating PTSD among veterans. Those taking classes this spring and summer will contribute to Kearney's study, which is funded by Puget Sound Partners for Global Health, a local research consortium funded by the Gates Foundation.

Mindfulness treatment asks participants to be aware of their thoughts and physical pain without judgment. It's easy to stew over negative thoughts, which can cause more stress and frustration.

By simply pausing to pay attention, people can notice patterns in their thinking and put thoughts into perspective to improve their lives. Deep breathing, meditation and yoga help with this process.

Scientific studies have shown the technique can help patients with a range of issues, including anxiety, depression, chronic pain and rheumatoid arthritis. Kearney hopes to add PTSD to that list.

"I quickly found that people with PTSD sought out the class to find additional ways of dealing with this problem," he said. "We've had many patients report to us the ability to be present in the actual moment helped their PTSD."

Lessens anxiety

PTSD is an anxiety disorder caused by traumatic experiences such as war or sexual assault. At the local veterans hospital, psychologists estimate 10-20 percent of combat veterans have the disorder.

Matthew Brazerol of Bremerton recently retired after serving 20 years in the U.S. Coast Guard. He enrolled in the VA's mindfulness class last spring after chronic pain and PTSD became debilitating.

"I came in with an open mind willing to try anything," he said.

Brazerol's responsibilities included recovering bodies and rescuing people. He said those cumulative experiences probably contributed to his anxiety. As the years progressed, Brazerol, 47, felt jumpy and anxious, and he would flinch at the sound of footsteps from anyone he couldn't identify.

After completing the mindfulness course, Brazerol said, his symptoms are less frequent. Practicing the meditation throughout the day helps him adjust his reaction to a painful memory, and he isn't as anxious.

"If you incorporate this into your life, it will help you regardless of what's going on," Brazerol said.

Not based on religion

Mindfulness treatment uses some Buddhist meditation principles, but the course isn't based on religious teachings. The classes were designed several decades ago by a physician at the University of Massachusetts Medical School.

In the last decade, mindfulness treatment has spread to hundreds of hospitals and clinics. In Seattle, Swedish Medical Center, Evergreen Healthcare and the veterans hospital are among those offering the technique.

Studies show that our thoughts can initiate a stress response in our bodies. First, we start thinking about a problem or concern. As we ruminate on these thoughts, the brain can send stress-response signals to other parts of the body, causing a faster heartbeat, shallow breathing and tense muscles. Prolonged stress can cause health problems.

But if we train ourselves to pause when that first thought enters the mind, we can largely control our physical response, studies have shown. Exercises such as deep breathing and meditation also help calm the body.

"The story we tell ourselves has a lot to do with the whole unfolding of the actual situation," said Dr. Jeff Brantley, director of the mindfulness program at Duke Integrative Medicine at Duke University Health System.

Wary of yoga mats

For people with PTSD, sounds and situations resembling a past traumatic event can trigger an anxious reaction. Kearney says his patients usually don't forget their traumatic experiences but can learn to live comfortably without having those memories take charge.

In other types of PTSD treatment, patients talk through painful memories and immerse themselves in experiences that cause the anxiety. While that form of therapy can be successful, veterans typically have a 25 percent dropout rate, said Matthew Jakupcak, a psychologist at the local VA's deployment health clinic.

In Seattle, the mindfulness classes have steadily drawn more interest among veterans — though many at first are wary of the yoga mats and meditation.

"It works, but I was skeptical," said Herb Washington, 46, who completed the course last year. The Oak Harbor resident fought in the first Gulf War and has suffered from chronic pain and diabetes. Washington was born with a foot condition that became aggravated in the military.

His pain isn't gone, but he doesn't depend so much on pain medication. He said he feels anger and frustration slip away when he does his mindfulness routine.

"It's a structured discipline," Washington said. "That's why I think it'll be effective for veterans."

More information

Mindfulness-based stress reduction

University of Massachusetts Center for Mindfulness: www.umassmed.edu/content.aspx?id=41252

Swedish Medical Center: www.swedish.org/body.cfm?id=1207

VA Puget Sound Health Care System mindfulness course: 206-277-1721

PTSD information

National Center for Post Traumatic Stress Disorder: www.ncptsd.va.gov/ncmain

Copyright © 2009 The Seattle Times Company

Source / Seattle Times

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Medical Marijuana Vs. Poison Pot (Shudder)

'The mainstream media remains amazed and, oftimes, inappropriately amused, when yet another study demonstrates that, far from being the brain-and-body-wrecking "weed of the devil," cannabis has wide-ranging health benefits.'
By Mariann Wizard / The Rag Blog / November 24, 2008

Gentle Friends --

News last week of yet more scientific evidence of the potential benefits of compounds in Cannabis sativa, the much-maligned marijuana plant, led me to reflect that I have been reviewing scientific studies of cannabis' medically-useful effects for 10 years for the American Botanical Council (along with studies of other medicinal herbs and alternative health practices). All of the information I've read and reviewed has been publicly available, but the mainstream media remains amazed and, oftimes, inappropriately amused, when yet another study demonstrates that, far from being the brain-and-body-wrecking "weed of the devil", cannabis has wide-ranging health benefits.

Q: Why does this public stupidity continue, in light not only of the scientific evidence (itself limited by a US government ban on research materials other than its own poor-quality crop) but of a much greater body of so-called "anecdotal" testimony from thousands of cancer, AIDS, multiple sclerosis, intractable nerve pain patients, and others with conditions ranging from arthritis to PMS and palsy that marijuana helps, and that the whole herb helps more than any one chemical component?

A: Eighty years of government and non-hemp industry (pharmaceutical, petrochemical, paper & forestry, cotton and now corn) PROPAGANDA. In support of this, I present for your delectation a little-known set of documents created and distributed in Austin, Texas, and replicated elsewhere, exactly THIRTY YEARS AGO: the Poison Pot Chronicles, when the US government had begun aerially poisoning Mexican marijuana plants with an herbicide, heedless of potential health consequences not only to hippie scum dopers in the US, and Mexican dope "cartel" growers, but to any innocent child, chicken or burro that might accidentally come in contact with sprayed plants. [See link to pdf. below.]

THIS IS HOW MUCH YOUR GOVERNMENT HAS CARED ABOUT YOUR HEALTH, "MY FRIENDS"; YOUR GOVERNMENT THAT IS, EVEN TODAY, "CONCERNED" TO PROTECT YOU FROM THE POTENTIAL CONSEQUENCES OF MAKING YOUR OWN DECISONS, AND TAKING YOUR MENTAL AND PHYSICAL HEALTH INTO YOUR OWN HANDS.

So remember, Kids, no matter how many studies show that cannabinoids can protect against Alzheimer's disease, until there is a patented pharmaceutical drug you can pay a doctor to prescribe and/or a pharmacist to provide and/or an insurance company to cover, DON'T SMOKE GANJA AT HOME!

For more information, please click here (3.1 mB PDF).

And, go to CannabisResource.

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Marijuana a Winner in 2008 Elections

Talk show host Montel Williams is shown speaking out in support of legalization of marijuana for medical uses. Williams has described his need for medical marijuana to deal with the pain associated with multiple sclerosis.
Voters say 'Yes' in Cannabis-related initiatives.
By Mariann G. Wizard / The Rag Blog / November 9, 2008

Marijuana-related measures on various ballots around the country did fairly well in last Tuesday's elections.

In Michigan, a medical marijuana initiative passed by 63% to 37%, making MI the 13th state to protect medical marijuana patients from arrest and jail. MI becomes the first medical marijuana state in the Midwest, and the second largest in the country (behind California).

In Massachusetts, a landmark initiative to decriminalize marijuana passed 65% to 35%, removing the threat of arrest for possession of an ounce or less of marijuana, and replacing jail time with a $100 fine, payable through the mail. This is the first time that voters anywhere have passed a statewide decrim initiative! Also in MA, four state House districts passed nonbinding public policy questions directing their representatives to vote for legislation allowing seriously ill patients to use cannabis, with the approval of their doctors.

In California, a measure that would have cut public housing benefits for those convicted of recent drug offenses, increased prison and law enforcement spending, and raised penalties for gang-related activities and other crimes, lost 70% to 30%. However, another measure that would have diverted more drug offenders from prison into treatment and improved the marijuana decrim law enacted by CA's lege in 1975 went down to defeat, 60% to 40%. Meanwhile, in Berkeley, a measure to expand non-residential zones where medical marijuana dispensaries can locate, issue zoning certificates, and bring the city's marijuana possession limits into line with recent court rulings passed, 62% to 38%.

Fayetteville, Arkansas and Hawaii County, Hawaii passed measures making adult marijuana offenses the lowest priority for local law enforcement, 66% to 34% in AR and 53% to 39% in HI.

For more information, go to Marijuana Policy Project.

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HEALTH CARE : Bone Density Drugs Can Do More Harm Than Good

Big Pharma Pushes Drugs That Cause Conditions They Are Supposed to Prevent
By Martha Rosenberg / July 24, 2008.

Yet again, women are the industry's main targets.

Like gastroesophageal reflux and bipolar disease, osteopenia began to inflict millions when a drug to treat it was patented.

"Osteopenia, or the risk of developing osteoporosis, was concocted as a disease at a World Health Organization osteoporosis conference in Rome in 1992 that was sponsored by two drug companies and a drug company foundation," writes Susan Kelleher in the Seattle Times.

Using the bone density measurements or "T scores" of a 30-year-old woman as a standard, the new condition, osteopenia, had "boundaries so broad they include more than half of all women over 50," writes Kelleher. And it didn't hurt that 10,000 bone density measuring machines appeared in doctors' offices to detect the new disease -- only 750 existed in 1995 -- many owned and financed by Merck, whose anti-bone-thinning drug Fosamax came online in 1995.

No wonder doctor visits for thinning bones increased by 5 million from 1994 to 2003, according to the Associated Press.

Of course, selling "prevention" to at-risk patients is a pharma gold mine.

It keeps patients on meds for decades through fear, alarmist marketing and after-this-because-of-this reasoning -- since a patient doesn't know if she would have gotten the disease anyway.

So even when reports of Fosamax-related jaw problems called osteonecrosis surfaced -- 1,000 cases have been documented -- and even when a study in the Archives of Internal Medicine this year found that Fosamax doubled women's risk of irregular heartbeat, which can cause clots and strokes, few doubted its primary action of protecting women's bones.

But now, like hormone replacement therapy, which also exploited women's fear of aging and social marginalization, Fosamax appears to cause the conditions it's supposed to prevent.

Since 2006, articles in the New England Journal of Medicine, Journal of Orthopedic Trauma, Journal of Bone and Joint Surgery, Journal of Clinical Endocrinology & Metabolism and Aging Clinical and Experimental Research have suggested the anti-bone turnover action of bisphosphonate drugs like Fosamax can in some cases cause fractures.

Oops.

While preventing bone loss that is caused by the process of bone turnover or remodeling, bisphosphonate drugs can fossilize and petrify a bone so it breaks spontaneously and with minimal trauma -- like chalk. It will not heal properly.

Thighbones of patients on bisphosphonates have "simply snapped while they were walking or standing," following "weeks or months of unexplained aching," reports the New York Times.

Like other fast-tracked-to-Wall-Street drugs that are effectively "tested" on the first users, adverse reports about bisphosphonates came from patients and practitioners long before they came from the FDA or manufacturers.

Bisphosphonate patients have documented excruciating pain from Fosamax since 2001 and GlaxoSmithKline's Boniva since 2006 on askapatient.com, many calling the drugs "poison" and saying they were forced into wheelchairs.

But only in March did the FDA alert health care professionals to the "severe, sometimes incapacitating, musculoskeletal pain" that bisphosphonate drugs could cause in their patients and caution them to consider whether musculoskeletal pain "might be caused by the drug" rather than the bone condition.

Not only is the pain that bisphosphonate patients report "not in their heads" -- imagine 1,257 men on askapatient.com saying their doc dismissed their constant pain and symptomology -- it is emblematic of what is really going on.

"There is actually bone death occurring," Dr. Phuli Cohan told Mallika Marshall, M.D., a medical reporter for Boston's WBZ-TV News in May. "People don't want to believe that this is happening, but it is a side effect of the medicine," she said.

Dr. David Hunter of New England Baptist Hospital concurs that bisphosphonates can cause "dead bone syndrome" and that patients should have a "drug holiday to allow bone cells to rejuvenate," reports Marshall.

Even drug reps on the industry chat room cafepharma are skeptical about bisphosphonates.

"They over-suppress the bone and 'may' cause subtrochanter fractures. ... It's the next hot button," wrote one anonymous poster on a thread titled "Is Boniva dead?" sparked by a rumor that Boniva pitchwoman Sally Fields had fallen and broken a bone.

Nor do bisphosphonates exit the body quickly when patients quit taking them, according to a 2006 study in the Journal of the American Medical Association -- rather, they remain for years.

(Patients "need not take costly bone-building drugs such as Fosamax for life to reap the medicine's protective benefits," was the News & Observer's upbeat interpretation of the drug's tenacity.)

Will bisphosphonates be the next hormone replacement therapy? Another example of women getting the diseases they were supposed to avoid, thanks to misogynistic marketing?

Is there a market for 10,000 used bone density measuring machines?

Source / AlterNet

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HEALTH : Eat Your Veggies!

The reason the United States now ranks 40th in longevity in the world is our massive subsidies of junk food, according to Public health officials. Here’s what real food can do for health.

Janet Gilles / The Rag Blog

Study shows how broccoli fights cancer
By Michael Kahn

Just a few more portions of broccoli each week may protect men from prostate cancer, British researchers reported on Wednesday.

The researchers believe a chemical in the food sparks hundreds of genetic changes, activating some genes that fight cancer and switching off others that fuel tumors, said Richard Mithen, a biologist at Britain's Institute of Food Research.

There is plenty of evidence linking a healthy diet rich in fruits and vegetables to reduced cancer risk. But the study published in the Public Library of Science journal PLoS One is the first human trial investigating the potential biological mechanism at work, Mithen added in a telephone interview.

"Everybody says eat your vegetables but nobody can tell us why," said Mithen, who led the study. "Our study shows why vegetables are good."

Prostate is the second-leading cancer killer of men after lung cancer. Each year, some 680,000 men worldwide are diagnosed with the disease and about 220,000 will die from it.

Mithen and colleagues split into two groups 24 men with pre-cancerous lesions that increase prostate cancer risk and had them eat four extra servings of either broccoli or peas each week for a year.

The researchers also took tissue samples over the course of the study and found that men who ate broccoli showed hundreds of changes in genes known to play a role in fighting cancer.

The benefit would likely be the same in other cruciferous vegetables that contain a compound called isothiocyanate, including brussel sprouts, cauliflower, cabbage, rocket or arugula, watercress and horse radish, they added.

Broccoli, however, has a particularly powerful type of the compound called sulforaphane, which the researchers think gives the green vegetable an extra cancer-fighting kick, Mithen said.

"When people get cancer some genes are switched off and some are switched on," he said. "What broccoli seems to be doing is switching on genes which prevent cancer developing and switching off other ones that help it spread."

The broccoli eaters showed about 400 to 500 of the positive genetic changes with men carrying a gene called GSTM1 enjoying the most benefit. About half the population have the gene, Mithen said.

The researchers did not track the men long enough to see who got cancer but said the findings bolster the idea that just a few more vegetable portions each week can make a big difference.

It is also likely that these vegetables work the same way in other parts of the body and probably protect people against a whole range of cancers, Mithen added.

"You don't need a huge change in your diet," he said. "Just a few more portions makes a big difference."

Source / Reuters / Yahoo! News / Posted July 1, 2008

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