Avoiding the sun as dangerous as smoking
- Created on Wednesday, 30 March 2016 15:18
A new study out of Sweden and published on Medscape, which is an online magazine for doctors, reported that nonsmokers who stayed out of the sun had a life expectancy similar to that of smokers who soaked up the most rays. Hence, not getting sufficient sunlight is as dangerous and life-shortening as smoking. The study involved nearly 30,000 Swedish women over 20 years.
This indicates that avoiding the sun "is a risk factor for death of a similar magnitude as smoking," write the authors of the article, published March 21 in the Journal of Internal Medicine. Compared with those with the highest sun exposure, life expectancy for those who avoided sun dropped by 2.1 years.
Pelle Lindqvist, MD, of Karolinska University Hospital in Huddinge, Sweden, and colleagues found that women who seek out the sun were generally at lower risk for cardiovascular disease (CVD) and such diseases as diabetes, multiple sclerosis, and pulmonary diseases, than those who avoided sun exposure.
And one of the strengths of the study was that results were dose-specific — sunshine benefits went up with the amount of exposure.
The researchers acknowledge that longer life expectancy for sunbathers seems paradoxical to the common thinking that sun exposure increases risk for skin cancer.
"We did find an increased risk of.skin cancer. However, the skin cancers that occurred in those exposing themselves to the sun had better prognosis," Dr Lindqvist said.
Some Daily Exposure Important for Health
Given these findings, he told Medscape Medical News, women should not overexpose themselves to sun, but underexposure may be even more dangerous.
"We know in our population, there are three big lifestyle factors that endanger health: smoking, being overweight, and inactivity," he said. "Now we know there is a fourth — avoiding sun exposure."
Sweden's restrictive guidance against sun exposure over the past 4 decades may be particularly ill-advised, the study finds, in a country where the maximum UV index is low (< 3) for up to 9 months out of the year.
Use of sunscreen is also widely misunderstood in the country and elsewhere, Dr Lindqvist said.
"If you're using it to be out longer in the sun, you're using it in the wrong manner," he said. However, "If you are stuck on a boat and have to be out, it's probably better to have sunscreen than not to have it."
Women with more pigmentation would be particularly well-served to stop avoiding sunshine, he said, adding that many people in India, for instance, follow guidelines like those in Sweden to avoid sun year round.
And because melanomas are rare among women with darker skin, benefit goes up in those populations when weighing sun exposure's risk against benefits, Dr Lindqvist said.
Age and Smoking Habits
The researchers studied sun exposure as a risk factor for all-cause mortality for 29,518 women with no history of malignancy in a prospective 20-year follow-up of the Melanoma in Southern Sweden cohort.
The women were recruited from 1990 to 1992 when they were 25 to 64 years old. Detailed information was available at baseline on sun-exposure habits and potential confounders such as marital status, education level, smoking, alcohol consumption, and number of births.
When smoking was factored in, even smokers at approximately 60 years of age with the most active sun-exposure habits had a 2-year longer life expectancy during the study period compared with smokers who avoided sun exposure, the researchers note.
.Role of Vitamin D Still in Question
The results add to the longstanding debate on the role of vitamin D in health and the amount of it people need, but this study doesn't resolve the question.
"Whether the positive effect of sun exposure demonstrated in this observational study is mediated by vitamin D, another mechanism related to ultraviolet radiation, or by unmeasured bias cannot be determined. Therefore, additional research is warranted," the authors write.
Dr. Cinque: Even the role of sunlight in causing skin cancer is not fully understood because it is not uncommon for people to develop skin cancers in areas which have not been over-exposed. Likewise, there are plenty of areas which, which for some people, are chronically over-exposed- say the arms of a fisherman- where the incidence of skin cancers doesn't correlate. Protecting the skin from too much sun exposure is definitely a good idea, apart from cancer, because we know it ages the skin and damages it. But, there are plenty of people who want to avoid the sun completely, and that is wrong. The sun's ultraviolet has a powerful anti-cancer effect which seems to work against every kind of cancer except skin cancer. And yes, skin cancer can be deadly, but caught early, it is about the easiest cancer to treat. Here's a good rule of thumb: if the sun exposure you are are getting is causing frank, visible tanning, then you're getting too much sun. The frank, visible tanning is a reaction to too much sun. And here's another good rule: if you want to protect your face all the time, it's fine. You are not going to suffer if that small part of your body doesn't get exposed to the sun. But, find large, broad areas of yourself that you can expose directly to effective sunlight for 10 or 15 minutes at a time. There is more danger if you don't than if you do.
Fasting triggers stem cell regeneration of immune system
- Created on Friday, 25 March 2016 13:25
From a new study out of USC, it was learned that in both mice and humans, fasting caused stem cell regeneration of the immune system, after damage was done by chemotherapy. Fasting was said to have "flipped a regenerative switch" activating the response of hemopoietic stem cells in the bone marrow which are responsible for building blood and immune cells.
“We are investigating the possibility that these effects are applicable to many different systems and organs, not just the immune system,” said Longo, whose lab is in the process of conducting further research on controlled dietary interventions and stem cell regeneration in both animal and human studies.
“We could not predict that prolonged fasting would have such a remarkable effect in promoting stem cell-based regeneration of the hematopoietic system,” said corresponding author Valter Longo, Edna M. Jones Professor of Gerontology and the Biological Sciences at the USC Davis School of Gerontology and director of the USC Longevity Institute.
The process involved the reduction in an enzyme known as PKA which is believed to suppress stem cell regeneration. “PKA is the key gene that needs to shut down in order for these stem cells to switch into regenerative mode. It gives the OK for stem cells to go ahead and begin proliferating and rebuild the entire system,” explained Longo, noting the potential of clinical applications that mimic the effects of prolonged fasting to rejuvenate the immune system. “And the good news is that the body got rid of the parts of the system that might be damaged or old, the inefficient parts, during the fasting. Now, if you start with a system heavily damaged by chemotherapy or aging, fasting cycles can generate, literally, a new immune system.”
The longest fast involved was 4 days, and it resulted in the removal of old, damaged immune cells and their replacement with new ones.
I have been involved in conducting fasts for people most of my adult life, and I have seen fasts much longer than 4 days. The longest fast I have ever done is 28 days. That's water-only for 28 days. And the longest fast I have ever supervised is 40 days. However, we know beyond doubt that there have been fasts much longer than that- longer than 100 days.
To many people, not eating for an extended period may seem drastic, but in practice, it's not as hard as it seems. For one thing, hunger disappears after a day or two. The ketosis of fasting, in which the body switches from burning glucose to burning fat, takes away the appetite. Most people feel quite indifferent to food while they are fasting. In fact, the biggest complaint we hear from fasters is not that they are hungry but that they are bored. And that's why we keep a lot of books and movies around to help them pass the time. Freeing the body from having to process food from scratch, saves the body a tremendous amount of energy and work. And, the process of living on one's reserves, forces the kind of cleaning-out of old damaged cells that we are looking for. The breakdown of tissues during fasting (in search of food) is a rigidly controlled process, and it results in discarding the bad and hoarding the good. You can compare it to peeling back the layers of an onion to get to younger, fresher tissue.
I am proud to say that I am one of the most experienced fasting practitioners in the world. And, I know that under the right environment and with the right conditions, fasting is one of the most healing and regenerative things that a person can do, as it aids and benefits a broad array of health issues. It would be great if the medical world became more aware of fasting and its potential to enhance human lives.
With aging, zinc nutrition suffers
- Created on Monday, 29 February 2016 04:32
A new study has shown that aging mice lose the ability to absorb and utilize zinc. For a long time, that has been suspected in humans as well. Dr. Walter Pierpaoli, who is responsible for introducing the world to melatonin, believes that the failure of zinc nutrition is responsible for much of the frailty and decrepitude of old age. And, he is very interested in preventing it. He discovered that melatonin tends to reverse the effect. Yes, melatonin enhances your body's ability to absorb and utilize zinc. And that is why he puts a little zinc in his melatonin supplement- so that it will be there at the same time as the melatonin, so that it can work on it.
Zinc absorption is a dicey situation even in the young. Are you aware that the essentiality of zinc in human nutrition wasn't discovered until the 1960s? And I'll tell you how it was discovered. It involved some growth-retarded boys in Iran. It was found that their diet was heavily weighted in unleavened bread made of wheat- which was high in phytic acid. Phytic acid, which is a form of phosphorus, binds minerals, rendering them unabsorbable, including zinc. Raising bread with yeast breaks down some of the phytic acid- so it is less of a problem. Even though I do not avoid wheat completely, I'm willing to admit that it's a food we should go light on, and some people shouldn't eat it at all.
But, phytic acid occurs in much more than wheat. It occurs in virtually all grains, nuts, and legumes, and also vegetables to some extent. Phytic acid is so widespread in plant foods, that's why they call it phytic acid, which means plant acid.
But, there is also oxalic acid which is also widely distributed in plants, including, fruits, vegetables, sesame seeds- even coffee beans. Oxalic acid combines with minerals forming insoluble oxalates which cannot be absorbed. The spinach family vegetables, including chard and beets, are high I oxalic acid, but there is some in just about every fruit and vegetable.
Because of these digestive antagonists, we only absorb a small portion of the zinc we consume. The recommended daily quota is 12 mg, but that is based on the idea that we will absorb just 20% of it. So, that means that only 2.4 mgs of zinc actually gets through. But, there may be times and conditions in which even less than that gets absorbed.
I should also mention that the fiber in plant foods- wonderful as it is- can also interfere with zinc absorption.
So, getting some supplemental zinc each day isn't a bad idea no matter who you are. But, if you are older, then it is especially important. Zinc is one of the top reasons why taking a good multi is a good idea.
By the way, an excellent source of zinc are pecans. They really are loaded, and pecan growers in Texas have to use a foliar spray of zinc or else the nuts won't fill out properly. I have a pecan tree at my health retreat that is not starting its 3rd year, and I give it foliar zinc as well. And, pecans are relatively low in phytic acid and oxalic acid, compared to other nuts. And what a tasty way to get your zinc.
So, the fact is that zinc is one of the weakest links in the modern diet, and the damage it is doing is probably incalculable. Making sure you are supplied with optimal zinc is one of the best things you can do for your health.
Mark Twain: A Man of His Time and of All Time
- Created on Thursday, 11 February 2016 02:49
My dear cousin Maria gave me The Autobiography of Mark Twain for Christmas. His life story is fascinating, and so is the history of his autobiography.
He started writing it in 1870- which was 40 years before he died. And before he began, he decided that he didn’t want it to be published until after he was dead. But, he was ambivalent about how many years after, ranging from as few as 50 to as many as 500. Yes, he actually contemplated having his autobiography held for half a millennium before being published. But, he wound up stipulating a 100 year wait. Yet, somehow, the first edition came out in 1958, which was 48 years after he died. Go figure.
Anyway, I think it’s pretty darn arrogant to assume that 100 years after you’re dead that people will want to read about your life- let alone 500 years. And all the more so when you consider that in 1870 when he started, he hadn’t even completed Tom Sawyer yet. So, he was very far from the pinnacle of his fame. However, on the other hand, he turned out to be correct in his prediction.
Another weird thing about the autobiography is that it was not written in chronological order. Randomly, he wrote about different times in his life, as the mood struck him, and he expected the book to be published that way, in this “stream of consciousness” style. But, the version that Maria got for me, which was edited by Charles Neider, is arranged mostly, although not completely, chronologically.
Mark Twain, whose real name was Samuel Clemens, was born in Florida, Missouri in 1835. Florida, by the way, means “land of flowers.” But, at age 8, his family moved to the larger town of Hannibal, Missouri to live with his uncle who owned a large farm there. And, since it was before the Civil War, the work on this farm was done by slaves. He told a very touching story about a slave boy named Sandy. Sandy liked to sing and hum. He did it all day long while he was working. But, Samuel didn’t like it, and he asked his mother to make Sandy stop. But fervently, his mother explained to him that Sandy had been torn away from his family in Virginia, and he was never going to see them again- all the people he loved. And if singing and humming provides him some relief from his sorrow, then she is glad for it, and she hopes he will continue, and Samuel should too. That had a huge effect on Samuel, and it changed his attitude towards Sandy and towards black people in general. He was never again bothered by Sandy’s singing. And, he wound up including Sandy as a character in Tom Sawyer. You recall the famous scene in which Tom finagles the other boys to paint the fence for him. Well, Sandy was one of the other boys, except that he doesn’t fall for it.
Both Tom Sawyer and Huckleberry Finn were based on Mark Twain’s childhood experiences in Missouri. And, another character from Tom Sawyer who was real is the second-most important character in the book: Injun Joe. There really was an Injun Joe; except that in the book, Injun Joe got trapped in a cave and starved to death, whereas in real life, Injun Joe got trapped in a cave but didn’t starve; after many weeks, he was rescued, having survived all that time on the flesh of bats.
Mark Twain had very little education. He never went to college. He just attended a little country school in Missouri, and it was 3 miles from his home. Year-round, he had to walk to school, and remember, they get some pretty serious winter in Missouri. Can you imagine a little kid having to wake up in the morning and then trudge through snow for 3 miles to get to school? And return home the same way? I’m thinking that there wasn’t too much childhood obesity back then.
Oh, and that reminds me: he wrote a lot about the food they ate on the farm, and he raved about it, all the incredible edibles they had. And he began by listing all the animals that they ate, including a lot of uncommon ones for our time, such as squirrels, possums, rabbits, ducks, geese, wild turkeys, wild hogs, deer, elk, even bears. It seems that the modern meat supply has contracted quite a lot in variety compared to back then, although being a vegetarian, I am unaffected.
I got the impression that Mark Twain was a real epicurean; he enjoyed his food and drink. He wrote this in the book:
“There are people who strictly deprive themselves of each and every eatable, drinkable, and smokable, which has in any way acquired a shady reputation. They pay this price for health. And health is all they get for it. How strange it is! It is like paying out your whole fortune for a cow that has gone dry.”
Now, that’s what I call a bad attitude about healthy living. Personally, I think there can be plenty of enjoyment in life even when one tries to live it healthily.
But, speaking of smoking, Mark Twain really loved his tobacco. He smoked like a fiend. Tobacco is what his uncle raised on the farm. Samuel started smoking at the age of 9. He became famous for brandishing his pipe, but he also smoked cigarettes and cigars. He also chewed tobacco. So, the fact that he lived to the age of 74, dying in 1910 of a heart attack, is quite amazing when you consider that average lifespan for men in 1910 was 50.
If you are wondering how Mark Twain got started writing, it’s simple. His older brother Orion had bought the local newspaper in Hannibal, and he got Samuel to come work for him. So, Samuel learned the ins and outs of newspaper printing, including typesetting and everything else. But, sometimes, they would be laying out the paper and realize that they needed another third of a page to fill it up. So, his brother would say, “write something” and Samuel did. And that is how he got started writing.
Eventually, the newspaper failed, not because it wasn’t popular but because his brother Orion was a lousy businessman who couldn’t balance the books and turn a profit. So, he sold it and moved to Iowa, and that’s when Samuel moved to St. Louis and got a job as a reporter for a newspaper. And that became his bread and butter, being a newspaper reporter.
But, very much like my cousin Gary, Mark Twain decided early in life that he wanted to travel; he wanted to see the world. And he did; he traveled to every continent except Antarctica. And often he got newspapers and magazines to pay for his trips with the understanding that he would write about it, and they would get to publish it. He told an interesting story about something that happened to him in India.
But first, let me say that he wrote a lot about all these girls and young ladies that he pined for in his youth. And from reading it, you get the impression that he wasn’t too successful with them, overall. There was this one, whom he called Mary although he admitted that it was not her real name, who was gorgeous, a real siren. She was a little older than he was, but he fell head over heels for her. She did not return the sentiment. But, decades later, when he was traveling in India, he was at a hotel, and he saw her. Well, he thought he saw her. He knew he couldn’t be seeing her because this was an attractive young girl he saw, probably in her teens. And he was in his mid-40s at the time. But, he thought there had to be a connection. So, he approached this girl and asked her about the girl he knew. Well, it turned out that this young girl was the granddaughter of the girl he knew, and that her grandmother was there, staying at the hotel. So, he went to see the grandmother, now a grey-haired old woman in her 50s, and they had a wonderful reunion. What were the chances of that?
He didn’t get married until 1870 at the age of 35. His wife, Olivia Langdon, was 22. Yet, he outlived her. He said that she was frail and beautiful. Their first child, a son named Langdon, lived just 22 months. Mark Twain held himself responsible for the boy’s death. It was winter, and he took him out for a carriage ride, but the boy was inadequately dressed for the cold, and he got sick and died. Actually, according to Mark Twain, the boy's leg actually froze. So, maybe he died of sepsis. Perhaps the boy needed an amputation.
Mark Twain never forgave himself, and he suffered a severe depression. And I had read elsewhere that he had long bouts of depression in his life. Don’t you find it ironic that a humorist should suffer with depression? Shades of Robin Williams? Or perhaps I should say that Robin Williams was a shade of Mark Twain. And I think the following passage is evidence of his depression. He was talking about the “maddening repetition of the stock incidents of our race’s fleeting sojourn here, which has oppressed human minds from the beginning.”
“A myriad of men are born; they labor and sweat and struggle for bread; they squabble and scold and fight; they scramble for little mean advantages over each other. Age creeps upon them; infirmities follow; shames and humiliations bring down their prides and their vanities. Those they love are taken from them. Misery grows heavier, year by year. At length, ambition is dead; pride is dead; vanity is dead; longing for release is in their place. It comes at least- the only unpoisoned gift Earth ever had for them- and they vanish from a world where they were of no consequence; where they achieved nothing; where they were a mistake and a failure and a foolishness; where they have left no sign that they have existed- a world that will lament them for one day and then forget them forever. Then, another myriad takes their place and copies all they did and goes along the same profitless road and vanishes as they vanished- to make room for another and another, and a million other myriads to follow the same arid path through the same desert and accomplish what the first myriad and all the myriads that came after it accomplished- nothing!”
Now, that’s what I call depressed.
His wife Olivia went on to bear three more children, all daughters, the first of whom was Suzy. Oh, did he love Suzy. He wrote so much about her and practically nothing about his wife. He would just mention that his wife went with him somewhere, but he had little to say about her otherwise, and little to say about his other two daughters either. But, he went on and on about Suzy. She was bright, observant, and sharp as a tack. At the age of 15, she took to writing her own biography of her father, and he included an excerpt of it in the book. And, it was very good writing too, and I mean for anybody, let alone a 15 year old.
Oh, but tragedy struck again. While he and his wife were in England where he was receiving some award, they got word by telegraph that Suzy had fallen ill. Then, meningitis set it. And remember: there were no antibiotics in those days. And at the tender age of 22, Suzy gave up the mortal coil. He and his wife weren’t even there to be with her, though her sisters were and other relatives. Mark Twain really turned a phrase when he wrote of Suzy: “She was our wonder and our worship.”
There is a lot in the book about his friendships with famous people, including General Ulysses S. Grant. He explained that even after he was President, that Grant preferred the title of “General” to “President.” And, I learned an interesting fact: that Mark Twain handled the publication of Grant’s memoirs. Grant was racing to finish them before he died, and he knew he was dying. He had all kinds of ailments- he was such an alcoholic. And, he actually finished it barely in time and promptly died. But, Mark Twain got it published, and he delivered the royalties to Grant’s widow, which came to half a million dollars. Now try to think about what half a million was worth in 1870s dollars. How many millions would it be today? I'm thinking maybe ten million.
It’s ironic that Twain and Grant should have become close friends when you consider that Mark Twain fought briefly for the Confederate Army in the Civil War. But actually, he was never in battle, and actually, he only served briefly. He essentially deserted- although he didn't use that term. And what he did was head west, first to Virginia City, Nevada, where he got a job as a reporter, and then on to San Francisco, where he did the same thing. And that’s where he came up with one of his most famous lines, “The coldest winter I ever spent was a summer in San Francisco.”
He also had close friendships with other prominent authors, such as Rudyard Kipling and Robert Louis Stevenson.
Another close friendship was with the Serbian electrical genius and inventor, Nikola Tesla. Twain was fascinated with science and technology, and he spent much time with Tesla in his laboratory.
Twain’s wife Olivia died in Florence, Italy in 1904, and again, he blamed himself because he was the one who was dragging this delicate woman of frail constitution all around the world because of his yen to travel.
And then, in 1909, the year before he died, his youngest daughter Jean died of typhoid fever. Therefore, his wife and all his children except for one, his daughter Clara, died before he did. Oh, the grief that that man must have suffered.
And towards the end of 1909, he announced to his remaining family and friends that he would be dying himself the next year, in 1910. But, he made an amusing story out of it. He said that he was born in 1835, which was the year of Haley’s Comet. And astronomers were predicting that Haley’s Comet would revisit Earth’s skies again in 1910, and they were right. So, Mark Twain said that it’s fitting for two freaks of Nature to come and go together. He died of a fatal heart attack on April 21, 1910.
Mark Twain is considered the greatest American humorist of the 19th century, but William Faulkner took it further. He said that Twain was “the father of American literature.” His best-loved books are The Adventures of Tom Sawyer, The Adventures of Huckleberry Finn, The Prince and the Pauper, and A Connecticut Yankee in King Arthur’s Court.
It is quite amazing that he made it to 74, considering how heavily he smoked. But, I don’t think he had any regrets about that.
In Cancer Screening, why not tell the truth?
- Created on Tuesday, 19 January 2016 21:13
This is an article by John Mandrola, MD which was published in Medscape on January 18, 2016. I am reproducing it here in whole. He argues that if you really look at the evidence that there is no increased life expectancy from all the cancer screening that is being done. That includes mammography for breast cancer, colonoscopy for colon cancer, chest x-rays for lung cancer, etc. His conclusion is based partly on the recognition that the only thing that really matters is overall mortality, not disease-specific mortality. And it makes sense because staying alive is the thing; it's the goal; it's the reason for doing anything. If the whole medical process which begins with screening and then goes on to definitive testing and then treatment, often radical treatment, is not going to result in you staying alive longer, what's the point? If a man can live just as long with untreated prostate cancer as he can by having it treated and going through the trauma, the pain, the disability, and often the impotence that results from treatment, why not just leave it be? Even just ignore it, although I'm not really recommending that. I think there are nutritional and lifestyle measures that can influence the course of prostate cancer a lot. But, let me put it this way: for a man my age or older (65) who is feeling fine, who is urinating fine, who has good sexual function, and is not in any pain, I certainly wouldn't let anyone cut on my prostate. What for? I am going to die anyway, but if there is no evidence that I am likely to live one day longer by operating, why do it? They say that 80% of men get some cancer in their prostate before they die anyway, and that if a man lives long enough, he's almost sure to get it. But, prostate cancer is usually very slow-growing and non-invasive. Operating just for good measure isn't necessarily a good measure.
So, read this article by Dr. Mandrola. I salute him because it took a lot of guts to write this.
Dr. John Mandrola:
An unpleasant emotion caused by the belief that something is dangerous. This is fear. This is cancer.
The motivation to screen for cancer, therefore, is easy to understand.
The problem: cancer screening has not worked. Recent reviews of the evidence show that current-day screening techniques do not save lives. Worse, in many cases, these good-intentioned searches bring harm to previously healthy people.
I realize this sounds shocking. It did to me, too. Millions of women and men have had their breasts squished, veins poked, lungs irradiated, and bowels invaded in the name of "health" maintenance. I've been scolded for forgoing PSA tests and colonoscopy — "you should know better, John."
I know what you may be thinking. We have all heard the anecdotes — cases that are often celebrated in local news reports and hospital marketing material. People saved by early detection, and the opposite: the unscreened felled by late-stage disease.
Anecdotes, however compelling, are not evidence. When you pull up a chair, open your computer, take a breath, suspend past beliefs, and look for the evidence that screening saves lives, it simply isn't there.
One reason that this many people (doctors and patients alike) have been misled about screening has been our collective attachment to the belief that if screening lowers disease-specific death rates, that would translate to lower overall mortality. That is: breast, lung, and colon cancer are bad diseases, so it makes sense that lowering death from those three types of cancer would extend life.
It is not so.
Facts, Not Fear
In a comprehensive review of the literature published in the BMJ, Drs Vinay Prasad (Oregon Health Sciences University, Portland) and David Newman (School of Medicine at Mount Sinai, New York), along with journalist Jeanne Lenzer, find that disease-specific mortality is a lousy surrogate for overall mortality. They report that when a screening technique does lower disease-specific death rates, which is both uncommon and of modest degree, there are no differences in overall mortality.
The authors cite three reasons why cancer screening might not reduce overall mortality:
Screening trials were underpowered to detect differences. I'm no statistician, but doesn't the fact that a trial requires millions of subjects to show a difference, mean there is little, if any, difference?
"Downstream effects of screening may negate any disease-specific gains." My translation: harm. Dr Peter Gøtzsche (Nordic Cochrane Center, Copenhagen) wrote in a commentary that "screening always causes harm. Sometimes it also leads to benefits, and sometimes these benefits outweigh the harms." To understand harm resulting from screening, one need only to consider that a prostate biopsy entails sticking a needle through the rectum, or that some drugs used to treat breast cancer damage the heart.
Screening might not reduce overall mortality because of "off-target deaths." An illustration of this point is provided by a cohort studythat found a possible increased risk of suicide and cardiovascular death in men in the year after being diagnosed with prostate cancer. People die — of all sorts of causes, not just cancer.
Let's also be clear that this one paper is not an outlier. A group of Stanford researchers performed a systematic review and meta-analyses of randomized trials of screening tests for 19 diseases (39 tests) where mortality is a common outcome. They found reductions in disease-specific mortality were uncommon and reductions in overall mortality were rare or nonexistent.
Drs Archie Bleyer and H Gilbert Welch (St Charles Health System, Central Oregon, Portland) reviewed Surveillance, Epidemiology, and End Results (SEER) data from 1976 through 2008 and concluded that "screening mammography has only marginally reduced the rate at which women present with advanced cancer and that overdiagnosis may account for nearly a third of all new breast cancer cases." Likewise, a Cochrane Database Systematic review of eight trials and 600,000 women did not find an effect of screening on either breast cancer mortality or all-cause mortality. This evidence caused the Swiss medical board to abolish screening mammography.
These are the data. It's now clear to me that mass cancer screening does not save lives. But I'm still trying to understand how this practice became entrenched as public-health gospel. It has to be more than fear.
How We Say It Matters
Dr Gerd Gigerenzer (Max Planck Institute, Berlin, Germany) offered a clue in his editorial accompanying the recently published literature review and analysis by Prasad and colleagues. He pointed to language and the ability of words to persuade. Instead of saying "early detection," advocates might use the term "prevention." This, Dr Gigerenzer says, wrongly suggests screening reduces the odds of getting cancer. Doesn't looking for cancer increase the odds of getting the diagnosis of cancer?
Gigerenzer noted two other ways language is used to emphasize screening benefits over harms:
The reporting of benefits in relative, not absolute terms.
The equating of increases in 5-year survival rates with decreases in mortality.
I would add to this list of word misuse, the practice of referring to women sent to mammography screening as patients. They are not patients; they are well people.
Dr Gigerenzer agreed with the commonsense notion that overall mortality should be reported along with cancer-specific mortality. His editorial included a fact box on breast cancer early detection using mammography provided by the Harding Center for Risk Literacy. I challenge you to tell me why such text boxes should not be shown to people before they undergo screening,
Fixing a Public-Health Problem
Given these revelations, I conclude that we have a massive public-health problem. Any expert in problem solving will tell you the first step of getting out of hole is to stop digging. I see three obvious next steps:
The first action healthcare experts should take is to spread the word that there is nothing about the mass screening of healthy people for cancer that equates to health maintenance. Embrace clear language. Saying or implying that screening saves lives when there are no data to support it and lots to refute it undermines trust in the medical profession.
The second action healthcare experts should take is to stop wasting money on screening. If the evidence shows no difference in overall mortality, why pay for it? I'm not naive to the fact that use of clear language will decrease the number of billable procedures. I am not saying this will be easy. One first move that would be less painful would be to get rid of quality measures or incentives that promote screening.
I want to be clear; I'm not saying all cancer screening is worthless. People at higher baseline risk for cancer, such as those with a family history of cancer or environmental exposures, might derive more benefit than harm from screening. Prasad, Lenzer, and Newman say this group of patients would be a good place to spend future research dollars. That sounds reasonable. I also acknowledge that some people, even when presented with the evidence, will want to proceed with screening. We can argue about who should pay for non–evidence-based medical procedures.
The most important action that all of us (patients, nurses, doctors, and healthcare writers) should take is to learn from this revelation. There's nothing bad about the fact that current-day screening tests don't save lives. Cancer is a tough disease, and in some ways, it may be the natural order of cell biology. What's bad about this medical reversal has been our blindness to the evidence.
We let what we believe become what we know. In clinical medicine, that should be a never event.
Time to stop statin treatment!
- Created on Tuesday, 12 January 2016 03:32
The above title actually isn't mine. It's that of Dr. Uffe Ravnskov, from his most recent newsletter. Uffe is a Swedish internist and nephrologist (kidney specialist) who has made it his mission to expose the truth about statin drugs and cholesterol. The news about statin drugs has always been bad because there has never been any clearcut evidence of benefit. The only thing clearcut about them is that they do harm, increasing the risk of cancer and diabetes. But now, the latest research shows that they are virtually of no value in preventing heart disease. You might as well take a placebo. But, it's even worse than that. Some of the research is showing that statins actually increase the risk of heart attack and heart disease. What follows is from Dr. Ravsnkov's latest newsletter:
"Do you know that on average statin treatment is unable to prolong your life by more than a few days? This was what Danish researchers found out after having analysed all statin trials, where the authors had recorded the total number of deaths. You can read more about it in Canada Free Press. The very article is freely available in BMJ Open."
"In 2004 new penal regulations on clinical trials came into effect in the EU. It was decided that no drug trial could be published unless the trial directors had reported about it before its start. In figure 1 of the paper by Okayama and coworkers the authors have shown that although the trials reported that statins were effective in lowering LDL-C, no significant benefits were observed in the trials published after 2004. The only conclusion from that finding must be that the drug companies have only published trials with a positive outcomes."
Trends in Prescription drug use in the USA
- Created on Tuesday, 24 November 2015 21:22
I received this from Medscape. It concerns changes in prescription drug use among Americans from the turn of the century to 2012. As you might have anticipated, prescription drug use went up, way up. Why would that be? A big reason, I suspect, is that prescription drugs are now advertised directly to consumers- in newspapers, magazines, and particularly on television.
The percentage of adults taking prescription drugs has risen to 59%, but realize that is an average, where it is lower among young adults and rises to 90% among seniors age 65 and older.
The bestselling prescription is still a statin drug to lower cholesterol: simvastatin otherwise known as Zocor. I agree with Dr. Uffe Ravnskov of Sweden who says that very few if any patients should be taking this drug or others like it. The statin craze is mostly just a racket. That's what he says, and I agree with him. I am lucky to have corresponded with Dr. Ravnskov, and he sends me his monthly newsletter. Dr. Ravnskov, who is a board-certified internist and nephrologist, is a medical maverick of the highest caliber.
Statins definitely do more harm than good, and it's not clear that they do any good at all. They increase the risk of both diabetes and cancer, and that's proven. There are big class action lawsuits going on right now over statins, including Zocor.
The next best-selling drug, lisinopril, an ACE inhibitor, which is usually given for high blood pressure, but I don't like it either. It is a dangerous drug. Right now, there are class action lawsuits being organized concerning liver damage and liver failure from lisinopril- where people have to get liver transplants.
There are better ways to lower blood pressure than taking that stuff.
The next drug, levothyroxine, is actually beneficial, and millions need it. It is thyroid replacement. The fact is that millions of people reach the point in life, sooner or later, in which they need thyroid hormone replacement. So, I'm not opposed to it. However, I think the natural desiccated thyroid, such as Armour, is superior because it contains T3 as well as T4, plus it's closer to bio-identical than the synthetic. It's also cheaper. Levothyroxine (Synthroid) is outrageously expensive, especially for a drug that has been around for as long as it has.
Next on the list is metropolol, which I do not like at all. It's a beta blocker, and they give it for high blood pressure. Do you really want to lower your blood pressure by weakening your heart? I don't know about you, but I want my heart to be as strong as possible, as strong as it can be. Yes, inhibiting the contractile strength of your heart may lower the stroke output and reduce your blood pressure a little, but so what. It's not worth it. By the way, people also take this drug for "social anxiety" and "performance anxiety" such as by musicians. It's actually very popular with musicians, but not with this musician.
Next on the list is metformin, which is the best drug in all of Modern Medicine. It is the best and safest diabetes drug- by far. And, it has widespread health benefits beyond that with very low risk of harm. The risk/reward profile of metformin is outstanding. Metformin lowers the risk of diabetes, cancer, and heart disease- the three biggest killers. I'm sure there are many thousands of people taking metformin who aren't even diabetic- just to get the anti-aging/life-extending benefits that are quite proven. So yes, metformin is good.
Next is hydrochlorothiazide which is a diuretic. Diuretics are given for all kinds of reasons including to lower blood pressure. Whenever there is excess fluid anywhere they prescribe a diuretic. But, taking it does not remove the cause of the fluid retention. So, it's just a symptomatic treatment. I am very negative about diuretics. There may be emergencies where people have no choice, such as if your lungs are full of fluid and you can't breathe, but there is altogether too much prescribing of diuretics in this country. I wrote an article about it years ago that is very well read, and I actually hear from people from all over the world who have seen and read this article:
Next on the list is omeprazole, which is a proton pump inhibitor for acid reflux. Nexium. I don't like it. I don't like it for its side effects, and I don't like it for its intended effect of killing stomach acid. You need your stomach acid. Everybody does. You need it to digest your proteins, and it protects you from infection. Think of the acid like a sterilizer for your stomach. So, I reject that drug too. There are other ways to deal with heartburn that don't involve destroying your stomach acid.
Next is amlodipine which is a calcium channel blocker, among the most dangerous of hypertension drugs. I don't like it. It's actually been shown to increase the risk of heart attack. Again, there are class action lawsuits going on over this drug. I do not feel good about it, and I would never take it- even if I had high blood pressure, which I don't.
The next bestseller is atorvastatin (Lipitor) which used to be the best-selling statin, but they refused to lower the price, so Zocor is outselling it. Lipitor is even stronger than Zocor. You should read: Lipitor: Thief of Memory by Dr. Duane Graveline, a NASA physician.
And finally, the tenth best-seller is albuterol, which is definitely necessary. Asthmatics use it as a broncho-dilator, to open up their airways. It does have problems, and in the long run, it may actually worsen asthma. So, asthmatics should definitely try to minimize their use of it. However, I don't dispute the need for it. When you gotta breathe, you gotta breathe.
So, that's the top 10 list of best-selling prescription drugs in America, and most of them I disdain. But fortunately, there are a few exceptions and two of them: thyroid replacement (which I prefer in the natural porcine form) and metformin are truly outstanding.
What follows is the article as I received it from Medscape:
In this study, researchers retrospectively analyzed the National Health and Nutrition Examination Survey database to determine if the prevalence of prescription drug use changed from 1999-2000 to 2011-2012. Household interviews with approximately 38,000 people were included. During the interviews, people were asked if they had taken prescription drugs over the prior 30 days and, if they answered yes, were asked to show the medication containers.
The main findings include:
The percentage of adults reporting use of any prescription drugs increased from 51% in 1999-2000 to 59% in 2011-2012.
The use increased as people became older. For example, for those aged 40-64 years, the use of one or more prescription medications increased from 57% in 1999-2000 to 65% in 2011-2012, whereas the use increased from 84% to 90%, respectively, in those older than 65 years.
Polypharmacy (use of five or more prescription drugs) increased from 10% to 15% among those 40-64 years old and from 24% to 39% for those over 65 years.
There was increased use of antihypertensives (from 20% to 27%); antihyperlipidemics (6.9% to 17%), primarily driven by statins; and antidepressants (from 6.8% to 13%), especially selective serotonin-norepinephrine reuptake inhibitors and selective serotonin reuptake inhibitors.
Narcotic analgesic use increased from 3.8% in 1999-2000 to 5.7% in 2011-2012.
Among those interviewed, 4.6% took antidiabetic agents in 1999-2000, which increased to 8.2% in 2011-2012, mainly due to greater use of biguanides, insulin, and sulfonylureas.
Prescription proton-pump inhibitors increased from 3.9% to 7.8% and anticonvulsants from 2.3% to 5.5%.
The 10 most commonly used individual drugs in 2011-2012 were simvastatin, lisinopril, levothyroxine, metoprolol, metformin, hydrochlorothiazide, omeprazole, amlodipine, atorvastatin, and albuterol.
All of the reported increases from 1999 to 2012 were not explained by changes in the age distribution of the population.
Lana: A life dramatic enough for a movie
- Created on Sunday, 18 October 2015 20:18
After reading her autobiography, I have to wonder why they never made a movie about the life of the 1940s legendary screen goddess Lana Turner.
She was born way up in the remote Idaho panhandle in 1921 as Julia Turner, and her circumstances could not have been more disadvantaged. That was mining country, and her father was a miner. but, they always struggled financially. It seems her parents only married because of her conception, and they had no other children. They separated when she was 9, and she and her mother moved to San Francisco. But, it was such a struggle for her mother, that she had to place Lana in foster care briefly, which Lana hated. Her father, who remained in Idaho, died in a knife fight over a card game. She was just 11 at the time, but, she had only good memories of her father.
After that, her mother and she moved to Los Angeles- in fact, Hollywood- where her mother sought work as a beautician. More devoted to her, her mother could not have been, and that was true for life. Her mother never remarried, and she lived for Lana.
When she was 16, Lana was discovered in a Hollywood ice cream parlor drinking a Coke. Taken with her beauty, the man who discovered her was the publisher of a Hollywood magazine, and he referred her to Zeppo Marx- one of the Marx brothers who, by then, had become a Hollywood talent agent. Reportedly, she, herself, chose the name “Lana.” That year (1937) she was cast in her first film as a sexy tight “sweater girl” who wound up a murder victim. Then, she signed a contract with MGM for $100 a week, which was a lot of money in those days. And from then on, her mother’s career became that of mother of Lana Turner. In other words, from then on, she lived off Lana, but believe me, she earned it.
From the very beginning, Lana Turner became synonymous with sex, even though she was only 16. She defined “sultry.” She soon starred in a Mickey Rooney movie in which she played the bad girl offsetting Judy Garland’s good girl, and there is a famous photo of the three of them together doing schoolwork on the set, as required by law, which enabled Lana to finish high school.
And speaking of sex, there were two revelations that Lana made at the start of her autobiography. The first was that she was terribly shy, and her greatest fear was public speaking. Like many stars, she contributed to the war effort during WW2, and in her case, it meant visiting the troops, including on some of the Bob Hope tours, but also on tours to sell war bonds, where she was expected to get up and speak as Lana Turner. Well, she could do it easily enough as somebody else, a character, but not as Lana Turner. But, the second revelation was that she never really enjoyed sex that much, that in real life, she wasn’t sultry and sexy like her characters. She said she enjoyed romance and tenderness and courtship, but sex itself was no big thrill for her. And her most enduring quote is: “A gentleman is just a patient wolf.”
But, if I had to characterize her 1982 autobiography, written 12 years before her death, I would say it oscillated between her movie career, film by film, and her marriage career, husband by husband. And, there were 7 in total.
But, oddly enough, the man whom she declared to be the “love of her life” was one she never married but almost did, the actor Tyrone Power. Today, he is remembered for being bisexual, although she claimed to never see any inkling of that side of him.
Her first marriage at the age of 19 was to band-leader Artie Shaw, but that was undertaken so compulsively (after one date) that it was doomed from the start. Her second marriage was to businessman Stephen Crane, and it was with him that she had her one and only child, Cheryl Crane. Husband number three was a millionaire socialite whom she wasn’t even attracted to, and it wouldn’t be a stretch to say that she married him for his money. Next came an actor who played Tarzan in the movies several times, Lex Barker. Daughter Cheryl would later write in her memoir that Barker sexually abused her during their marriage, but, that wasn’t mentioned in Lana’s autobiography.
That marriage was followed by Lana’s harrowing relationship with mobster Johnny Stompanado. He was a real-life monster who beat her and abused her, and she literally feared for her life. She went to England to make a movie with Sean Connery, and Stompanado followed her there and stormed on the set, where Sean Connery had to physically subdue him. Then, they got Scotland Yard to deport him back to the US. And when Lana returned, it was Oscar time, which she attended with her mother and her daughter. Lana had been nominated for her role in Peyton Place, although she stood no chance of winning. (I should mention that Lana’s mother is the one who really raised Cheryl. Lana set them up in a house with another older woman who was like a second grandmother to Cheryl. Lana paid for everything, but she was more like a doting aunt than a mother.) But, that night, after the Oscars, Johnny stormed into her house, enraged that she didn’t take him to the Oscars. That resulted in a severe beating, and while she was being beaten, Lana kept worrying that 14 year old Cheryl, who was staying over that night, would be awakened in the next room. Well, Cheryl was awakened, and she did come into the room, but not before going into the kitchen and getting a carving knife. When she entered, she saw her mother bloody, battered, and bruised, and she saw Stompando approaching her mother with a wooden clothes hanger in his raised hand. It looked to Cheryl like he was about to hit her mother again. So, she shoved the knife into his belly. The blade really didn’t go in that far, but as luck would have it, it hit the abdominal aorta, and he bled out very fast. (Was that good luck or bad? I’d say good.)
The first thing Lana did was call a doctor friend. He came over and tried to resuscitate Stompanado, unsuccessfully. Next, she called her lawyer, who came right over. And that’s when they called the police.
The legal system never came down very hard on Cheryl. She did have to remain in custody for several weeks until the grand jury hearing. But even by then, Lana still had bruises left from the beating Stompanado had given her, which she displayed to the jury. And mercifully, they declared it a “justifiable homicide.” However, the judge, rather wisely in my opinion, didn’t let Lana off so easy. He pointed out that she’s the one who put Cheryl in that deplorable situation. So, he removed Lana’s parental rights and made Cheryl a ward of the state. But, he also made Lana’s mother Cheryl’s court-appointed guardian. So, nothing really changed in regard to the living situation. But, it involved regular probation visits for Cheryl, and court-ordered psychiatric visits for both Cheryl and Lana, which they did. Lana was so grateful that Cheryl got off without prison that she didn’t care about the rest. She gladly cooperated.
Lana’s next husband was a rather nice guy, compared to the others: the actor Fred May. And she was a little vague as to why they divorced, although she did say that him dipping into her money had something to do with it. But, they remained lifelong friends, and she always spoke well of him. But, the last two marriages which followed were awful; expensive and awful; including one to a much younger man who was serially unfaithful, a pathological liar, and an out-of-control spendthrift with her money, and the last one to a nightclub hypnotist who stole from her- cash, jewelry, whatever he could get his hands on. And that did it. After that, Lana finally stopped getting married. Thank God.
I won’t go into her movies too much because I want to focus on her health. But, I will point out that one of her early roles was Ziegfeld Girl in which she played a Broadway star who rises fast but then falls hard to alcoholism. But, in the movie, there was a song written for her by Nacio Herb Brown, You Stepped out of a Dream, which became Lana Turner’s theme song for the rest of her life. Whenever she entered a club or walked on stage, they played that song, and it is a fabulous song. Her most celebrated movie is The Postman Always Rings Twice, also considered her most sultry role. In Peyton Place, she played the single mother of a lone daughter- which mirrored her real life. Although she was nominated for Best Actress, it was really more of a supporting role than a leading role. The Bad and the Beautiful with Kirk Douglass was and is very highly acclaimed, but I’ve never seen it. And Imitation of Life was about a white woman who climbs to the top as an actress while raising her only daughter, while also living with a black woman who also had an only daughter. So, the relationship among the four of them is the story of the movie. And it was a very important project for Lana Turner because it was the first movie she made after the Stompanado killing, when it was uncertain whether her movie career would survive at all.
But now, let’s talk about her health because there are some interesting observations I can make.
First I want to point out how interrelated health and beauty are, how dependent beauty is on good health. Sparkling eyes, peaches and cream complexion, lustrous hair, svelte tone, etc. are the products of good health. And since her beauty was her stock in trade, you would think that health would have been a top priority for her, but it wasn’t. Lana Turner was a smoker; a heavy smoker, and she started young. In fact, she got in trouble for smoking on the sets as a teenager, and she complained bitterly about it because she wanted to smoke, and she felt she had as much right as anybody. There are quite a few photos of Lana Turner holding a cigarette, but, I learned that there would have been quite a few more if they hadn’t airbrushed them out.
She also drank. In the book, she played down her drinking, saying that she was more of a “sipper” than a “drinker”. But, others said otherwise. Most of her husbands were big drinkers, and she drank with them. Often, her husbands would get mad if she didn’t drink as much as they did. But, the fact is that women cannot handle alcohol as well as men. The female liver does not process alcohol as fast- doesn’t convert ethyl alcohol into acetaldehyde as rapidly. The result is - that for a given amount of alcohol- women experience a higher blood level of alcohol than do men, and it persists for a longer period of time. It is true across the races; women of all races cannot handle alcohol as well as men. And in the book, she admitted that she often self-medicated with alcohol. For instance, during the time that she was tormented by Johnny Stompanado, she drank heavily. And others who knew her said that she was, in fact, a big drinker and at times an alcoholic.
The only other drug she mentioned in the book as one she took was marijuana, but that was mainly during her brief marriage to Artie Shaw because he was a big pot smoker. But, like many people, she often took sleeping pills.
Regarding her diet, it wasn’t very good. Just the standard American diet, with an emphasis on meat. In the book, she mentioned steaks, chops, burgers. Fried chicken was mentioned as a favorite. Otherwise, it was the usual things; they had a barbecue; they had a birthday cake; they ate doughnuts on the set, etc. etc. Not a single fruit or vegetable was mentioned as being a favorite of hers.
Lana Turner developed appendicitis at the age of 17 and underwent surgery. But, that surgery was botched, and she had to undergo a second surgery for it at the age of 18 to fix it. Realize that people don’t develop appendicitis for no reason. It isn’t normal. It really shouldn’t happen to anybody. There has to be a morbid and abnormal condition in the digestive tract for appendicitis to happen, and it’s due, of course, to faulty diet: specifically: not enough fruits and vegetables; not enough fiber; and too much meat.
Lana Turner was lucky in that she had a nice figure, a nice shape, with dazzling proportions (36-23-36, reportedly) despite conventional eating habits. But, she was physically active; she enjoyed tennis and swimming; and it’s fair to say that she was naturally athletic.
But, she kept having miscarriages, so what does that tell you? She had at least 3, and she may have had more. That is, she may have had some miscarriages without knowing it- before she realized she was pregnant. So, all was not well inside her. It’s a bad sign if a young woman can’t carry a baby to term. She also had two abortions. The first was with first her husband Artie Shaw, but she didn’t realize she was pregnant until after they split up. It was a back alley thing because abortion was illegal then, and she almost died. The second abortion resulted from her relationship with Tyrone Power, but at least that one went well without complications.
I had read previously that Lana Turner really didn’t age well in the face, that the luster faded from her rose early, meaning in her 30s, and that what kept her going was one thing: makeup. And, she kind-of alluded to it in the book. She said that she brought her own makeup person on the sets to work with the studio’s. But, she said that there were instances in which, because of stress, lack of sleep, too much drinking, etc., they just couldn’t capture her look. They would try different angles, different lighting, but in the end, they just had to shut down production for the day because Lana Turner was nowhere to be found.
And it was the same way in her private life. She said that during her marriage to Fred May, what irked him about her is how long it took her to get ready to go somewhere. And he got sarcastic about it. He would tell her: “Now look: we’re going out with friends tonight at 6 PM, and I want you to be ready. It’s 10 AM, so you should get started: hair, nails, make-up, clothes; whatever. Just be ready by 6.” Invariably, she wasn’t.
But, it was the 1980s that her health really started falling apart. She was in her 60s and still acting some- not in movies, but on television and in live theater, when she started losing weight and getting very weak. Her weight plummeted to 95 pounds. I don’t know that she was diagnosed at that time, but for the first time, she stopped what she was doing and started focusing on her health. She spent much time at a health retreat in Hawaii where her daughter Cheryl was living. And she claimed to undergo a spiritual awakening that involved her renewing her faith as a Roman Catholic. She recovered well enough to return to the public eye, but mainly at charity functions and award presentations. Then, in 1992, at the age of 71, she was diagnosed with throat cancer- which was surely the result of a lifetime of smoking and drinking. She quit doing both, but it was too late. And, the last three years of her life were miserable, preoccupied with debilitating radiation treatments and chemotherapy. She really clung to life- she wanted to live- but it was to no avail. Her weight sank to 85 pounds, and she died, skin and bones, on June 29, 1995 at the age of 74.
Lana Turner hasn’t enjoyed the spectacular posthumous career that Marilyn Monroe has. But, I think Lana was lucky to make it to 74 considering how she lived and all the stress she had. It’s a shame that she was so unlucky in love. Her memoir does not speak well for the male gender, and I’ll point out (since it’s public knowledge) that her daughter Cheryl became a lesbian. Hmm. I wonder if it was because of what she saw and heard and experienced at the hands of the men in her mother’s life. I just have to hope that Lana Turner has found more peace in the next life than she found in this one.