Scary supplements

I just came across an article with the provocative headline “Use of dietary supplements lead to 23,000 emergency visits each year” based on a 2015 NEJM study. This article seems to be suggesting that supplements are hazardous and should be avoided or at least more heavily regulated. Actually, they explicitly quote a physician who talks about the untested-ness and unregulated-ness of dietary supplements.
It also said that of this estimated 23,000 ER visits each year, there are “more then 2,100 hospitalizations”annually from supplements (
average hospital admission from ER visits is 11.9%, a little more frequent than the 9.1% admission rate we see here). That sounds like a lot of visits and hospital stays. Are supplements really that dangerous?
Conveniently, the same page also had links to some other ER statistics:
  • Annual ER visits related to schizophrenia in young adults is 382,000 (over 16 times more common that from supplements), of which about half are hospitalized as a result (nearly 90 times more common than supplement-related admissions)
  • Nearly 100,000 seniors are admitted to the hospital annually because of emergencies caused by adverse drug events. That’s over 47 times the number from supplements and that’s just in seniors.
  • 1.1 million annual ER visits from drug poisoning (once again, over 47 times the number from supplements), of which 24.5% are hospitalized (over 128 times more hospitalizations than from supplements)
  • The are around 24,000 ER visits for treadmill-related injuries annually, making treadmills more dangerous to the country than supplements
  • Apparently, even mirrors are more dangerous than supplements with 24,943 mirror-related injuries in 2014. There are even more injuries from sound recording equipment (44,278) and television sets and monitors (61,136). Interestingly, protection devices (12,829) injuries seem to be a bit safer than supplements, but do remember that ER visits for supplements are often just that someone took a lot or an unknown number of a supplement and are going to be sure it’s safe, so in many of these cases, there is no actual injury - just worry.
So, certainly, it’s worth paying attention to what you are taking and not throwing caution to the wind, but supplements are hardly the public health hazard that articles like this are trying to imply.

Interview in Crazy Wisdom Journal

Last fall, I was interviewed in the Crazy Wisdom Journal (CW is a local bookstore and hub for local healing arts), and the interview was recently published. Like all written materials, things have changed slightly since it was written, but it’s mostly up to date. It’s pretty in-depth and long, but I don’t think it’s too boring to finish.
For people who want to get a better idea of my philosophy of health care, this is a good read.
Also, for people who like to nitpick, there is a small error on page 44 (don’t worry, it starts on page 42: it’s not
that long) where I said “disease sensitivities” instead of “food sensitivities”.
In any event, it is a decent read and the PDF can be found by clicking here (the article starts on page 42):
The Crazy Wisdom Interview with Malcolm Sickels MD, or if you’d like to read it in your browser, click here for the flip book.

How effective is the Shingles vaccine?

These days, the shingles vaccine (for herpes zoster) can be found at just about any pharmacy. However it’s been hard to find real numbers on the benefit of this vaccine and so once again scare tactics come into play to get people to get the vaccine. How effective is it really? (Please note all these studies were done on healthy seniors, whose incidence of shingles is higher than younger populations.)
A
new study came out which adds to a previous study showing that the vaccine reduces the burden of illness by 50% and the incidence of post-herpetic neuralgia (where the pain of shingles never goes away) by 60%. In the new study, it looks like the benefit of the vaccine drops dramatically after the fourth year, so people would need to get a new shot every 5 years or so.
So, the cumulative risk reduction is about 50% for getting shingles and 60% for getting post-herpetic neuralgia, which sounds great, but what does that really mean for the person getting the shot. After all, if you wore a metal helmet around all the time, it might reduce your risk of getting killed by a meteorite by 50%, but the risk of getting hit my a meteorite is so small in the first place (less than 1 in 5 billion/year) that it’s not worth the trouble to wear the helmet.
In the study, the annual risk of getting shingles in seniors was 1.1% without a vaccine and 0.54% with the shot, meaning 0.57% of the people who get the vaccine will avoid shingles because of it. Put another way, if 175 people got the vaccine 1 person wouldn’t get shingles because of it. Usually, shingles is a temporary annoyance (about 1 in 8 seniors getting shingles will get post-herpetic neuralgia), so 175 shots and $38,500 (around $220/shot) seems like a lot to prevent 1 case of shingles. But wait! The shot gives similar protection for about 5 years, so we have to amortize that cost over 5 years: 35 shots and $7,700 to prevent 1 case of shingles.
However, post-herpetic neuralgia can be quite devastating, so what does it cost to prevent that? The risk in seniors is about 0.14% per year and goes down to 0.046% with the shot, so 0.09% of those who get the shot will avoid post-herpetic neuralgia each year. That’s 1087 shots, but spread over 5 years it’s only 217 shots to prevent 1 case of post-herpetic neuralgia at a cost of around $48,000. Compare that to the risk if avoiding a second heart attack by taking a statin: 50 people taking it for 5 years to prevent 1 heart attack at a cost of (say $20/month on the cheap end: $1200/person x50 people) $60,000.
What does all this mean to you? If you are a senior and get a shingles shot (for about $220), you have a 1 in 35 chance it will prevent you from getting shingles over the next 5 years and a 1 in 217 chance it will prevent you from getting post-herpetic neuralgia in the next 5 years. Better odds than wearing a meteor-protecting helmet (everyone on the planet would have to wear one for a few years to prevent 1 death from meteor), but still something to think about.
Also, note that having shingles is at least as effective at preventing future episodes of shingles as the vaccine is, so no need to get the vaccine if you’ve had shingles within the past five years.
Finally, understand that this is only looking at the simplest to measure outcome of the vaccine and monetary costs associated with it. Costs from side effects haven’t been discussed. Whatever immune dysregulation may occur from this vaccine is not only difficult to measure (it isn’t going to happen right away so would be hard to connect with the event of being vaccinated), but actively hidden (any reaction severe enough do trigger a lawsuit and prompt enough to implicate a vaccine bypasses the normal court system and goes to a special vaccine court, where all outcomes are kept secret, so there is no record of how much of a problem there is from any vaccine).

Time will tell.

Recently, I had a new patient who had been inappropriately placed on Fosamax (a bisphosphonate) for a bone density that just barely edged into the osteopenia range. She didn’t like being on it and persuaded her doctor to take her off it after 5 years. Recently, another doctor put her back on it (after 8 years off) because her bone density was about the same (i.e. still osteopenia).
Now, I know that 15 years ago, Fosamax was new and the
drug reps were pushing it hard and everyone thought it was the bee’s knees, so it’s understandable (but not justifiable) for her doctor to have placed her on Fosamax then. Now, however, it’s generic so there’s no drug rep pushing the medication, so why would a physician be prescribing it inappropriately?
Well, despite my
pointing out that this is poor practice by the evidence five years ago, an article on the current evidence of these medications’ lack of benefit with long term use only came out today after FDA presentations about the lack of efficacy.
The risks have been continually underplayed: osteonecrosis of the jaw and atypical fractures. Both of these, like most side effects, are dramatically under-reported. An oral surgeon isn’t going to want it getting out that a patient got osteonecrosis of the jaw, so is going to avoid working on people with risk and downplay what does happen. Meanwhile, atypical fractures aren’t going to get reported simply because the people seeing them (mostly ER docs) are too busy and are just trying to get the patient better. So, the true incidence of these risks is probably dramatically higher than what is reported in the literature.
It’s unfortunate that the real data on risks and lack of benefit of these medications only comes out once the medication goes off patent. We see the same with the PPIs (Prilosec, Nexium, etc): nutritional docs have been pointing out the risks for years, but now that they are off patent, the risks of pneumonia, bone loss, and small intestine bacterial overgrowth are starting to trickle out into the mainstream press.
Could it be that media corporations are hesitant to bite the hand that feeds them? Ever since direct-to-consumer drug advertising started, those advertising dollars have bought silence from the news outlets in addition to interest from patients. Perhaps the for-profit media is only willing to speak ill of a drug once it’s gone generic and the profits have already dried up.

HBOT for Horses

Last monday there was an article in the New York Times on using alternative therapies for treating racehorses. Among the treatments discussed was hyperbaric oxygen for healing up muscles better and faster.
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It’s nice that the benefits of
HBOT are getting some recognition. By delivering more oxygen to the tissues, it can speed wound healing and help bring damaged tissues back from the brink.
There’s more and more data on the benefits of using it and we’re finally starting to see
some research on the benefits of mild hyperbaric therapy (1.5 atmospheres pressure or less).

Settling for treatment

I was talking to some of my neighbors today about IPT (Insulin Potentiated Therapy), and how it uses lower doses of chemotherapy with fewer side effects than conventional chemotherapy and may even produce better outcomes (though there’s not much research on it). One of them asked why more doctors aren’t learning how to do this. To me, the reason seems straightforward in our current medical system: there’s no economic incentive to do it.
In order to learn to do IPT, a doctor needs to take time off work to learn to do it. That means no income for that time (actually, losing money since overhead costs remains when the doctor isn’t working) without much potential for increased revenue after learning the treatment. Hospitals and offices make money from delivering chemotherapy by marking up the drugs they are giving in addition to charging for services. More chemo and higher priced chemo (recent cancer drugs cost 20-200 times more than older drugs and may not give any more substantial benefit) means more money to keep the offices open and funds to cover fancy new cancer clinics and free art therapy classes. So, using less drug (IPT typically uses 10% of the usual dose) or older drugs (a vial of an old medication can be as little as $15 where a vial of a newer drug like Topotecan costs nearly $2000 per vial and others cost more... remember that chemo may use multiple vials and costs to administer the drugs will add substantially to the price) would substantially reduce the revenues of these offices and hospitals.
With big organizations, money drives everything they do and a potential loss of income (switching from larger margin chemos to smaller amount of cheaper drugs) isn’t going to contribute to a healthy bottom line.
It is an unfortunate reality that in this country there’s more interest in doing more expensive procedures than a less expensive procedure that may perform better.

Gluten in hemp milk

I’ve heard a case report of hemp milk having gluten in it. After noticing a reaction that correlated with hemp milk drinking, one person sampled every brand and flavor she could find and they all tested positive for gluten with an in-home kit. She had a conversation with one of the companies who told her that the farmers who grow hemp also grow barley, so cross-contamination is probably the issue.
Yes, the hemp milk was labeled gluten-free, but in the US right now there is no legal definition of gluten-free. So, if there’s any lesson in this, it’s that we should push the FDA to hurry up and settle on a definition of what “gluten-free” means.

I'm not crazy: aspirin for everyone?

I sometimes start to wonder if I’m crazy when conventional docs continually and persistently do things that I’m sure are a bad idea. Are they all practicing bad medicine or am I crazy? It’s nice when I’m reassured that I was right all along.
This time, it’s about aspirin. Whenever anyone over the age of 35 goes into a doctor’s office, it seems like the doctors routinely put them on an aspirin a day. The dose of aspirin depends on the doctor’s specialty: primary care docs recommend 81mg and cardiologists want people on 325mg or more.
Ostensibly, the aspirin is to reduce the risk of heart attacks. It reduces the stickiness of platelets (which make blood clot), making them less likely to clump and clog up arteries and cause heart attacks and ischemic strokes (caused by a clot).
However, aspirin is (like most drugs) not an entirely benign substance. It can cause bleeds in the stomach and intestine, which can be worsened by the anti-clotting actions of it. In addition, it can increase the risk of any type of bleeding, particularly hemorrhagic strokes (caused by a bleed rather than a clot: less common but worse).
Recent research has demonstrated that while aspirin does reduce the risk of another heart attack in people who have had one, it isn’t so impressive in people who have never had a heart attack. In particular, the only people who haven’t had a heart attack yet who should be candidates for daily aspirin use are people over 45 (men) or 55 (women) who are already at high risk of a heart attack and don’t have risk of bleeding (BP is close to normal and not at risk for falls).
Now the big question: if some should get aspirin, what dose should they get? Once again, the
primary care docs provide better care than specialists: 81mg provides better risk reduction and less increase in risk than 325mg. In fact, it appears that higher doses of aspirin might blunt the anti-platelet effects in addition to increasing the risks of adverse events (however it appears that cardiologists might not be reading their own journals like Chest).
So, how effective is it? Well, 119 high-risk men under 60 would need to take aspirin for 5 years to prevent one heart attack. Over those 5 years, there is a little more than a 1 in 3 chance that someone in that group will have a major intestinal bleed because of the aspirin. Put another way, if we took 1000 men with a 6% 10-year risk of hart attack and gave them aspirin for 10 years, we will have prevented 19 heart attacks (dropping the number from 60 to 41), caused 8 major bleeds and 1 hemorrhagic stroke. Men can
look up their risk/benefit ratio here.
In women, the benefit is less impressive: the chance of preventing a stroke is less and isn’t that different from the chance of causing a bleed. Women can
look up the specific risk/benefit ratios here.
However, if you are
having a heart attack, one of the best things you can do (in addition to calling 9-1-1) is chew up and swallow an aspirin. I’d still make the phone call first, though.

Finally some clear-headed thinking about flu shots

Just as the media frenzy is reaching a fever pitch about the swine flu (variant H1N1 influenza), the Atlantic has a well-researched and thought-out story about the holes in the data supporting the utility of the flu shots in the first place. Mike Adams has a reasonable, point-by-point summary of the story as well. However, allow me to summarize the fundamentals of the story:
  • While the influenza vaccines have become a ritual in the fall, there is no reasonable evidence that they do any good.
  • The studies that the influenza vaccine supporters use to justify the shots is quite lousy. On one hand it claims a 50% reduction of total death rates (which is patently absurd since it would then have to also prevent heart attacks, traffic accidents and other things that have nothing to do with the flu), and on the other hand they refuse to do any quality studies on the vaccines since they claim it would be unethical. (The 50% reduction is based on cohort studies, so it compares people who voluntarily got the shot to those who didn’t. At the time of the studies, not that many people got the shot and they were mostly people who were trying to stay healthy and avoided doing risky things and thus had a lower mortality rate at baseline.)
  • By examining death rates during times when there was a shortage of flu vaccine (2004) or there was a completely ineffective vaccine (the strains that hit the US weren’t any of the strains that were in the vaccine in 1968 and 1997) we see that the lack of effective vaccination does exactly nothing to the death rate, ergo the vaccine doesn’t affect the death rate.
  • In a best case scenario, the vaccine would only build up antibodies in people with robust immune systems. These are not the people who are at risk from the flu.
  • Evidence for benefit of antiviral medications is about the same quality and timbre as for the influenza vaccine. On average it only knocks 1 day off the time someone’s sick with the flu (at $10/pill taken twice daily), and Gilead (who makes Tamiflu) was required to take back its earlier claim of benefit for the medication by putting this up on their website: “Tamiflu has not been proven to have a positive impact on the potential consequences (such as hospitalizations, mortality, or economic impact) of seasonal, avian, or pandemic influenza.” (Also note that Donald Rumsfeld, a major stockholder of Gilead’s, was Secretary of Defense when the military got $1.8billion to stock up on Tamiflu and then his president asked congress to approve legislation for another $1billion to stockpile more–all of which led to a greater than 50% jump in the stock’s price.) All this for a 20% incidence of medication side effects that seem to be worse in children. Also, viruses mutate so quickly that using lots of antivirals when not absolutely necessary will only lead to widespread resistance and a loss of whatever benefit they might give.
  • The medical establishment has decided that flu shots are good despite the lack of decent evidence for it and will attack anyone saying otherwise. Mr. Adams labels this as quackery (a fair turnabout of when orthodox medicine accuses others of practicing things not supported by evidence).
There are a few dots that the article fails to connect, however:
  • The writers say that no one knows why there’s more flu in the winter, which is technically true. However, a good deal of evidence points to less sun exposure and lower vitamin D levels as a major component of the increase in incidence. Read point 3 at the end of my last article on swine flu to see some of the evidence or go read more at the vitamin D council’s website.
  • The 1918 “Spanish Flu” that killed 40-100 million people is the pandemic flu that everyone is worried about. It’s thought that if we had another like it we would be in trouble and this is why everyone gets so excited about H1N1. However there are several differences between then and now. 1918 was near the end of WWII, so health care and nutrition were pretty bad across the world. In 1918 there were very few antibiotics, so the secondary pneumonias that would kill people were left unchecked. Finally (as pointed out by Dr. Starko in Clinical Infectious Diseases and discussed in the NYT science section), 1918 was when global marketing for that new “wonder” drug aspirin was in full force (the patent had just expired and Bayer fought to preserve its marketshare by using massive advertising campaigns while other manufacturers pushed to build their markets) and the surgeon general and the US Navy both recommended using aspirin for the flu (we now know that using aspirin in a viral illness can cause Reye’s syndrome and so discourage it’s use during viruses) while the recommended dose was double the maximum dose used today. These massive doses of aspirin can cause the symptoms exhibited by the people who died early in the course of the disease. So, with late deaths looking like bacterial pneumonia and early deaths looking like aspirin overdose, it’s certainly reasonable to think that even if the same 1918 Spanish Flu virus came around again there would be much lower rates of complications and death.
Finally, the article in the Atlantic offers a useful sidebar with answers to questions about H1N1 influenza and immunity. It does a good job of delivering the basic information about the flu, treatment and vaccination, including the tidbit that nearly all the current flu is H1N1 so the current seasonal vaccine is essentially useless even if it did work.

Swine flu over the cuckoo's nest

Nearly every patient is asking me these days if I have any thoughts about the new novel H1N1 flu, also known as the swine flu. Yes, I do have some opinions. Of course, like everything else, this should not be construed as medical advice, talk to your doctor, blah blah blah.
First, let me apologize to Chicago magazine for baldly stealing the title of this article from an article they had back after the 1976 swine flu vaccination fiasco. In case you don’t remember, in 1976 there were 2 strains of a swine flu that hit the US but only resulted in one death (they were fairly limited in how much they spread). Public-health officials got alarmed (remember that the 1918 influenza that killed 10-20% of those infected (over 500,000 Americans died) was thought to be a swine flu) and recommended immunizing the entire population of the country. The vaccinations started in october and the first day three seniors died shortly after receiving the shot (though they were never proven to have died from the vaccine and there didn’t seem to be any further events like this reported) and then there were some cases of Guillain-Barré Syndrome (GBS), a few of which resulted in death. By the time the vaccination program ended, over 48 million people had been vaccinated (over 20% of the population). There were 1098 cases of GBS reported, though only half of those were linked to the vaccination, and 25 people with GBS died. This means that a little more then 1 in 100,000 people got GBS and one in twenty of them died. So, the vaccine wasn’t especially dangerous, but it was more dangerous than the swine flu that year.
Now, the swine flu this year is clearly nowhere near as deadly as the 1918 influenza. Recently, it’s been estimated that 10% of New York City has already had the flu and there no reports of large numbers of empty apartments cleared out by the flu. Also, England recently
downgraded their estimate of the number of people who will die from it to as low as 3,000 (if only 5% are infected) or more likely around 19,000, while the regular flu kills 6-8,000 each year.
So, while this novel flu is clearly more dangerous than the regular flu, it’s not the plague that was being predicted. As for the various conspiracy theories about the virus being man-made because it contains DNA common to other flu viruses, they conveniently manage to neglect the fact that this is how viruses normally adapt and rearrange themselves.
The current swine flu is susceptible to treatment with oseltamivir (Tamiflu) or zanamivir (Relenza)
according to the CDC, but they only trim 1-2 days off the duration of the illness (amantadine seems to be ineffective against it). Neither of these have ever been tested on pregnant women, Tamiflu has been tested on kids down to 1 year of age while Relenza is only approved for children 7 and over, and you may recall the report of some kids in Japan jumping off a building during a Tamiflu-induced delirium during the bird flu craze. Generally, however, the drugs are well-tolerated but will only do their trimming of 1-2 days off the total duration of the flu if the drugs are started in the first 2 days of the flu. Also the drugs should be limited to only those at high risk for complications: the ill and infirm.
The vaccine is supposedly safe and effective (at least, in so much as
any influenza vaccine is safe and effective) despite not being available yet (actually, there are reports of it just starting to become available). I’m not a fan of the regular flu vaccine and not much more of a fan of this one. Of course adding any thimerasol (ethyl mercury) containing vaccine to your body should only be done for sound benefit, realizing that the effects of the mercury may not manifest for years. While there have been some alarms sounded about squalene in the vaccine causing GBS and worse, the only official information I’ve found about squalene in the vaccine suggests that it isn’t being used now and would only be used if the vaccine supply suddenly needed to be expanded massively, however it’s listed under various names so it may be in there and people may not know it.
So, on to the big question: what can you do to prevent yourself from getting swine flu? It’s fairly elementary:
1. Wash your hands. The virus gets into you usually by contact, so keep ‘em clean.
2. Keep your fingers out of your face. It needs to get into your body and your face has the most enticing routes of entry. 2 lines of defense: a moat and a wall.
3. Take some vitamin D. A
recent article shows the clear association between season and latitude (and therefore vitamin D status back when people went outside) and 1918 influenza pandemic survival: more vitamin D led to less death. Reports by 2 physicians who keep their patients’ vitamin D up to good levels shows a profound reduction in influenza among those replete with vitamin D. If you can get your 25-OH vitamin D level checked, take enough to get it up to 50 ng/ml (it generally takes 1,000 iu daily to make it go up 10 points and can take 3 months to level off, so you could double the dose for the first week). If you can’t get your level checked, take 2,000 iu daily (you could double it the first week). Remember all these guides are for normal sized adults and vitamin D does have some toxicity at higher levels (over 150 ng/ml), so don’t go crazy with it.
4. Take some vitamin C every day. White blood cells need vitamin C to do their jobs. Give them what they need, at least 1,000 mg daily, spread it out if you can manage it.
5. Get enough sleep. I can’t say enough about the importance of sleep for the immune system.
6. If you do get sick, IV vitamin C may knock the flu back quite a bit (if not completely eliminate it). Read
dr. Klenner’s papers about his experience with using IV vitamin C for various illnesses. See also dr. Weeks’ article on using vitamin A at the onset of the flu.

The Fosamax facade is starting to crumble

After years of hints that all the bisphosphonates (medications used for osteoporosis) caused jaw osteonecrosis (destruction of the jaw bone after dental work), a new article shows that the risk of jaw osteonecrosis when the person gets dental surgery who has been on Fosamax is one in 23, or around 4%, 1600 times higher than the 0.0005-0.0025% Merk “estimated” in 2007.
While 4% may not seem like a big number, it seems a lot more problematic when realizing how devastating jaw osteonecrosis can be. The jaw bone near the surgery breaks down, leaving a broken jaw, and it can continue to expand. Any attempt to bridge the gap will cause further destruction, as drilling into the bisphosphonate saturated bone will only trigger more breakdown. With no known way to remove the bisphosphonate from the bone once it’s in there, all the dentist can do is watch helplessly as the jaw falls apart.
Hyperbaric oxygen therapy is the only treatment that has shown any promise in stemming the collapse and even that isn’t stunningly effective.
Understandably, dentists are reluctant to operate on people who may be at risk due to the devastating effects on the patient, and are also reluctant to report it happening due to the devastating effects on their reputation and office. So, the condition is dramatically under-reported. Even with less loaded conditions, 90% are never reported.
Of course, this is on top of the risk of erosions and cancer of the esophagus from these medications.
The companies making the bisphosphonates (Fosamax, Actonel, Boniva, Aredia, Zometa and Reclast) have been attempting to portray these medications as safe and effective for the treatment of osteoporosis as well as attempting to expand the market to include the treatment of osteopenia (milder bone loss). Clearly, if one in 23 of people on the oral form of these medications (the IV form is much worse) will have their jaw disintegrate if they get dental surgery, it’s not safe. Whether it’s effective is open to debate.
When trying to prove that putting their new chemical into people is a good idea, drug companies and the researchers that work for them have a lot of tricks to make the chemical that they’ve dumped a pile of money into producing look good enough to produce the serious return on investment they need. Drug companies like to use intermediate markers rather than outcomes since they are easier and cheaper to measure and easier to game than the real outcomes we care about. With cardiac disease, the outcome we’re concerned about is dying or having a hospitalization, while cholesterol or LDL levels are an intermediate marker that may not translate into the outcomes I mentioned. With bone loss, the real outcome is fractures, while an intermediate marker is bone density. By strapping a lead rod behind your leg, it can look denser to the machine, but it won’t do a thing to reduce fractures. While a medication may increase bone density (remember that density is mass per volume, so heavier bones), it may not actually make them stronger (they can be dense and brittle, or lighter but with just enough give to resist breaking: think glass compared to titanium).
While the drug companies have been doing their typical attempt to brush it all under the rug, they also engaged in their typical pastime of trying to get doctors to prescribe it to people for whom it isn’t indicated. As I
discussed 18 months ago, the evidence doesn’t support the idea that this drug is beneficial for osteopenia. Perhaps the only thing that does support the idea is the money the drug companies spend on lunches for physicians so they can whisper these sweet nothings in their ears.

Where did the testosterone go?

Back when I was giving talks on men’s health, I would talk about testosterone and how it goes down with age and that there is also a decline from one generation to the next: the testosterone levels in a 60-year-old in 1988 were higher than a 60-year-old in 1996, which were higher than one in 2003. Understandably, the men were shocked and demanded to know why. At that point, all I could say is that no one knows for sure, but it’s probably some chemical we’ve been adding to the environment and mentioned the feminized male alligators in Florida where PCBs had been dumped in the lake years earlier.
Well, we finally do have a candidate for a cause of the lower hormone levels in men: phthalates, specifically DEHP. The
Journal of Andrology published a study showing that higher levels of the DEHP metabolite MEHP consistently accompanied lower levels of testosterone and estrogen. This also implies that it will cause similar hormone disruption in women (earlier studies have shown an association between phthalates and genital defects in infants), making it a good thing to avoid.
These phthalates are mostly used in making flexible vinyl for flooring, wall coverings, “food contact applications” (food packaging, though this is illegal in Europe), and medical devices. Other, lighter, phthalates (DEP and DBP) are used in lotions, perfumes, cosmetics, lacquers, coating, varnishes, acetate, and in some time release medications.
Interestingly, DEHP is relatively insoluble in water, so little will migrate from the plastic (DEHP doesn’t become a permanent part of the plastic) into a mainly water containing liquid. Because of this, US law permits DEHP in packaging of food that is primarily water. However, since DEHP accumulates in fat over your entire lifespan and persists in the environment it is likely the only safe level of it is none.
One this stuff gets in you, how do you get it out? Well, there’s no good answer for that right now. Sadly, the only sure way to be sure to move it out of a human is to have a baby: some of those phthalates will leave inside the baby. There have been some attempts to do it with Olestra (the non-absorbed fat in Wow chips), but it didn’t work (though it might work if you have just been exposed to the fat-soluable chemicals before they have gotten into your fat).
I had switched to phthalate-free medical supplies (mostly IV tubing) long ago, so applying the precautionary principle in my office has paid off. I wonder when the government will put the health of its citizens over corporate profit. Right now, they hear more from the corporations’ lobbyists (paid for out of the money we pay for their stuff) than from us, so as long as we sit on our hands and keep quiet it won’t change.

In case you need another reason to avoid corn syrup

High fructose corn syrup (HFCS), a very pervasive ingredient in american foods, may well be the lynchpin of our obesity epidemic. It doesn’t trigger satiety (feeling full) like regular sugar, so people eat more of it (and its empty calories), and it’s processed differently that normal sugar leading to higher triglycerides and fatty liver disease (also known as NASH or non-alcoholic steatohepatitis). In addition, it’s sweeter than sugar, so normally sweet things taste less sweet in comparison, triggering the dietary arms race of adding sweeteners to foods just so they taste sweet compared with everything else (have you noticed that “no-added sugar” fruit juice popsicles now have aspartame in them?). That the corn it’s made from is grown from frequently genetically modified stock and uses large amounts of fertilizers (mostly petroleum based) to grow just adds to the reasons to avoid it. Now, news just came out that adds another reason to the pile.
Yesterday,
Environmental Health published an article (as did the Institute for Agriculture and Trade Policy) showing that 30% of the foods they tested with large amounts of HFCS had detectable levels of mercury in them. Mercury is, of course, a potent neurotoxin and not something you want in your diet, especially when you’re not exposing yourself to it for any good reason (since there’s no benefit to eating HFCS).
Why is there mercury in HFCS? Making HFCS uses numerous chemicals including chlor-alkali based sodium hypochlorite, hydrochloric acid, and caustic soda, all of which have mercury involved in their manufacture. Every year the plants that make these report that they end up with less mercury than they started with (including mercury from plant emissions) and that a substantial amount is “missing”: escaping the plant in the products they produce. So, when these chemicals with mercury are used in the manufacture of other products (like HFCS), some of the mercury ends up in them.
As usual, the industry trade group (the Corn Refiners Association) tried to muddy the waters about the article, claiming that the methods of making hydrochloric acid and caustic soda (notice they didn’t mention sodium hypochlorite) that involve mercury are outdated and mostly not used in the US any more. However, some is still produced in the US with mercury today and some is imported from countries with even less stringent laws than ours. So, despite the Corn Refiners Association’s protestations, this is still very much a current issue.

What's the deal with the flu shot recommendations?

The flu season is approaching and people are starting to ask about getting the flu shot. The CDC recommendations came out a couple months ago and claimed that there are 36,000 deaths annually from the flu so everyone should get flu shots. I’ve become a bit skeptical of these recommendations.
Do you remember back in 2004 when one of the factories (Chiron) that made flu shots
had a problem and had to junk its entire output for the year? At that point, there was only enough demand to justify 2 companies making the entire amount for the whole country. One factory can't meet its amount for the year and then suddenly there's not enough and all the "health authorities" go into a tizzy about the lack of flu shots. Fewer people got vaccinated and nothing much in reality changed: no bump in flu deaths or anything.
Now, in order to reduce the risk of this happening again, we need to have more places making it, but in order to get that to happen, there has to be more demand. How do you do that? Expand the criteria for who needs one and then stir up the fear about flu so the people are frothing at the mouth to get a shot. So, rather than shot recommendations based on valid health concerns, the recommendation becomes based on economic concerns.
Frankly, the original recommendations for flu vaccine are the only ones that are supportable: for people for whom a flu would be enough to push them over the edge (frail, nursing homes, etc.) and the people who care for them. Everyone else was gravy for the vaccine makers. Expanding the definition of who needs it to "chronic disease" and huge swaths of ages covers a much bigger chunk of the population and ensures enough of a demand to justify more manufacturers.
As far as the recommendation for children and pregnant women, it's unconscionable to inflict further vaccines onto an already overburdened childhood vaccine schedule when the justification is ensuring a demand for flu shots. Even worse is giving thimerasol-containing vaccine to pregnant women: the developing fetal brain is particularly vulnerable to the ethyl mercury in the vaccine.
Even for the targeted population, the shot is of questionable utility. The virus that the flu shot protects against covers only a small proportion of the things people get sick with and call "the flu", and the match between the vaccinations and the strains that go around every year aren't very good: after the season is over they invariably say "well, it was only a partial match for what actually went around." One study demonstrated that the vaccine only reduced the severity of the flu but slightly increased the incidence of it in the people who got the vaccine.
This article summarizes the data on the effectiveness of the vaccine in adults as only 30% effective in preventing flu-like illness and didn’t affect the hospitalization rate overall nor the amount of time off work. In the elderly (65 and over), this article shows that in the community (most people who would be reading this, as opposed to institutionalized in a nursing home or hospital) the flu vaccine is not significantly effective against the flu, flu-like illness, or pneumonia. However, for people who are institutionalized, there does seem to be a clear benefit.
Now, I know people still like to reduce their risks of getting something that may knock them out for a week or so, so for a couple years I tried to get the vaccine, but I wasn't willing to put mercury into people's bodies to do it. To that end I tried to pre-order "preservative-free" vaccine for the upcoming flu season (buying flu vaccine is like getting rock concert tickets: the sales open and everyone rushes to snatch stuff up), but every time all the preservative-free stock was snatched up leaving only the exact same stuff with thimerasol in it left available (and this is before the stuff has even been made: why can't they just change the supply to meet the demand?). The first year I discovered that at the end of the season there was some preservative-free stuff left over, which I got and made available. I haven't been able to get it since, so I gave up.
So if you are determined to get the vaccination, I would try to get the preservative-free stuff (which Kroger claimed to have last winter). Otherwise, being sure you have enough vitamin D (check a 25-OH vitamin D level and get it well into the normal range, I like to get it to 50 ng/dl or more) and take vit C at least daily.
Am I recommending not to get the vaccine? No, I'm just trying to add some perspective so people can make their own decisions. For most people it isn't a matter of life and death and it comes down to if it will make your life easier. Read the fourth paragraph before this one (especially the last sentence) and make your decision.

If you want some perspective of the risk of death from influenza, it's a little obfuscated by combining it with deaths from pneumonia (which is much deadlier in general than influenza) in the data available from the CDC for 2002
here, but let's do the best we can. Incidentally, this report gives the total number of flu/pneumonia deaths for 2002 as 65,681, so I have to say I'm skeptical of the number of influenza deaths given in the CDC/MMWR report (35,000) and, indeed, looking at the references it cites, it appears the authors misread the article and used the number for chronic disease-related deaths rather than the influenza-related deaths which is less than 1/3 of the number: 8,097. This, then, implies that less than 1/4 (actually only 12.3%) of the flu/pneumonia deaths are actually from the flu, so we'll use this number.
So, in the age 1-4 group (for which universal annual flu vaccination is recommended) the combination for flu and pneumonia accounted for 110 deaths in 2004, while the US population aged 1-4 was nearly 16 million. Thus, assuming _all_ the deaths were from flu, there would be ~150,000 children vaccinated to prevent one death (assuming that vaccinations would be 100% effective in preventing death from the flu, which is unlikely considering the matches generally are 50% or less). Far more likely, less than 25% of the kids' deaths were from the flu and it is less than 50% effective in preventing death from the flu, so we're looking at over 1,200,000 1-4 year olds vaccinated to prevent a single death. To break it down to purely economic terms, that's over $20 million to prevent one death, not a good use of funds when there are more cost-effective ways to prevent deaths for children aged 1-4. Then, consider the incidence of side-effects of the vaccinations: is the incidence less than 1 in 1,200,000? The vaccine adverse event reporting system is designed to minimize the reporting of these events as being vaccine related, and with the data available
here we can calculate that with 62 million flu doses distributed and 1400 adverse events, there's about 1 adverse event per 45,000 doses. This means that in order to save that 1 life we have to tolerate 27 adverse events on the way. Yes, most adverse events aren't life threatening, but (overall for all vaccines since the data isn't broken down by vaccine) 15.8% were in 2001, so we're looking at 4 additional hospitalizations or deaths on the way to maybe preventing one death. Even this article demonstrated that there is “little evidence” of benefit of vaccination in children under 2.
For the next recommended universal vaccination group >50, some segments have vanishingly small amounts of flu deaths: it's not in the top 10 causes of death for 55-64 y.o. americans and not in the 45-54s either, so we can safely assume that it's a minor risk (<0.4% of deaths) for the entire 50-64 age range. There's 45 million people who won't significantly impact their risk of death with a flu shot.
FInally, we're getting to the age range who shows some risk: 65 and older. 3.2% of deaths (59,000) are in the flu/pneumonia category, so a drastically smaller amount of over 65s, perhaps 15,000 died of flu in 2002. But remember that when you die, you have to die of something, so in some of these cases, flu was merely the last straw. So, with a population of 35.5 million over 65s in 2002, there's less than 1 in 2000 dying of the flu, and with the vaccine being less than 50% effective that's over 4000 vaccines (>$80,000) to prevent 1 death.
However, 4000 vaccines to prevent 1 death isn't that bad, but realizing that the flu is much more likely to kill someone who is already on the edge (among over 65s, those 85 and older were 16 times more likely to die of influenza, says
JAMA), it would be much easier and more cost effective to target those people and vaccinate them and their caregivers. Which brings us back to the original recommendation for the vaccine: those likely to die from catching the flu and the people who take care of them.
So, why all the recommendations for more vaccinations? 16 million 1-4 year olds and 45 million 50-64s means the they are recommending 60 million vaccinations that aren't remotely supported by the data. It's got to be to ensure an adequate market for the vaccine. Either that or someone's making a good profit off it.

Tempus fugit: BHRT Summit 2 and Pain Release book bonuses

Two interesting opportunities to Learn Useful Things About Health (something I quite enjoy doing and highly recommend) are coming in the next couple days: an opportunity to get a pile of free stuff just for buying what should be a good book (provided you do it on November 8 at Barnes & Noble), and the second BHRT World summit.

Dr. Dan Benor, MD, (a doc I’ve been familiar with for a few years and who seems to know what he’s doing) has a book out about a simple and rapid method of releasing both physical and emotional pain,
7 Minutes to Natural Pain Release. The urgent part is that if you buy the book at Barnes & Noble on November 8, 2008, you can then use the receipt to get a pile of free bonuses: interviews with the author, audio seminars and classes on a variety of health topics, and a pile of e-books (including “Caring, Housing and Health of Your Dog”, which is what tipped me into deciding to get it on Saturday). The book is only $18, though if you decide to forego the bonuses or miss November 8th you can get it as an e-book for only $10. You can follow the link or click on the picture to see the bonuses.
image

The other upcoming opportunity is the second
BHRT World Summit, starting November 10 and continuing through November 25 with interviews with 10 health experts about bio-idential hormones and other therapies. The interviews are aimed at the general public to educate you about some more holistic approaches to improving our health. There are 3 options for taking part: $29 to get the interviews on the days they are broadcast only, $49 to listen to them whenever you want, or $120 to listen anytime and get a transcript of all the interviews and downloadable files of all the talks so you can listen away from your computer. I got the complete package last time and, while there were a couple small points where I disagreed with the doctors, was glad I got it and even I learned a lot from the talks. You could learn a lot, too. Follow the link or click on the banner to sign up. There’s a few bonuses with this, too, so check it out.
BHRT2

Sample treatment outline

When I had a layover thursday on the way to the ACAM convention, I ran into a woman who’s had multiple medical issues and was walking around with a backpack full of medications. She’s been going to a variety of specialists and overall her problems have been dealt with using a variety of medications. As we got to talking, she shared some of her diagnoses with me and I mentioned some other avenues she may want to investigate.
Now, I will probably never see her again, but she stayed on my mind as she’s a complex medical case. With the variety of problems, most doctors get frustrated and throw up their arms in frustration or try the couple therapies they have at their disposal then reject the patient if they don’t work. This doesn’t help the patient.
So, perhaps she will have a chance to read this and be able to take advantage of some of these therapies (I’m only including the diagnoses and avoiding any personal details so she’ll be the only one who can identify herself from this information). For everyone else, you’ll get a chance to see the approach that I take.
Her problem list includes (I wasn’t taking notes, so this relies on my memory and may have some errors): thyroid cancer in the past (eventually had entire thyroid removed) but doing well until last winter when she had sudden onset of attacks or episodes of (I don’t remember the details) fatigue and palpitations. Since then she has been diagnosed with multiple sclerosis (can only tolerate one MS drug), bone loss, massive iron deficiency anemia, massive vitamin D deficiency (I think she said she needed 60,000iu weekly just to bring her to perceptible levels, Ehlers-Dahnlos (not type 4), autonomic dysfunction, mast cell instability, hypoglycemia, orthostatic hypotension, some muscle/tendon shortening from limited use, and probably a few other things. She has tried an elimination diet in the past, eating nearly exclusively chicken and rice and felt weaker and lost weight during that time.

In terms of going after some of her current diagnoses directly, here are some things that she could try (you’ll notice some things come up more than once):
History of thyroid cancer and now completely without a thyroid: with her other problems, she may not be converting T4 (in synthroid, what is usually prescribed) to T3 (the active thyroid hormone), sometimes lab tests can help but sometimes you just have to do a trial of the different forms (Armour thyroid, cytomel, or compounded thyroid hormones) and see where the patient feels the best.
For her MS: Estriol (one of the estrogens, this is the weakest estrogen and least inflammatory) ~6 mg daily (this is the estrogen that is most elevated in pregnancy which is one time women with MS have fewer symptoms, a trial of estriol showed reduced white matter lesions in women with MS on estriol) applied transmucosally (this avoids the first pass liver metabolism that gives more metabolites from taking pills); vitamin D, enough to get her blood levels up to 60 ng/ml (plenty of data showing a connection between low vitamin D and MS); low dose naltrexone 3-4.5 mg before bed (learn more about it from
this website); it’d be good to check her stomach acid production as it’s typically low in people with MS (I had a patient the other day who took nearly 2 hours to reacidify her stomach, normal should be under a half hour, so this means food isn’t getting digested).
Bone loss: she’s already taking calcium and magnesium, but extra magnesium may be warranted and the form of calcium certainly matters in someone who’s likely low in stomach acid (and another reason to check her stomach acid); enough vitamin D is essential for calcium metabolism so we’ll make sure she’s over 60 ng/ml;
estrogen can help keep her bones strong and we already have another indication for using estriol and progesterone can help to encourage growth of the bones while testosterone (bringing back up to normal levels only) is also important for keeping bones strong; weight bearing exercise; maybe some additional supplements to support her bones.
Iron deficiency anemia: she can’t tolerate regular iron (ferrous sulfate), so while some IV iron may get her levels up right away, she should take a more gentle iron like bis-glycinate or some other chelated iron and take it with vitamin C to increase absorption; also, resistant iron deficiency anemia is a red flag for gluten intolerance or helicobacter pylori infection, so those need to be ruled out.
Ehlers-dahnlos: this is a connective tissue disorder that is typically genetic, so without knowing what the genes in her situation are coding for (they code for enzymes and other proteins so knowing where the defect it you can sometimes get around it) I would at least recommend a decent amount of vitamin C since it is essential for collagen formation and making strong tissues.
Mast cell instability: quercetin is a bioflavanoid that stabilizes mast cells and may be more effective than the cromolyn that she’s taking now (see
this book).
Orthostatic hypotension: licorice can help retain sodium and may help her get her blood pressure up, though she may well have adrenal problems so a thorough evaluation of them would be warranted.
Autonomic dysfunction: once again, adrenal problems here, too, though this is a shoe-in for the environmental illness work-up below.
Hypoglycemia: small frequent meals is the mainstay of treatment here, but using more protein and fat can stabilize things a bit; sometimes food allergies can be an issue here.

More global solutions (we’re trying to find the root cause so she doesn’t need to be taking all this stuff) since when someone has all these problems there’s often something behind it:
More thorough allergy evaluation and repair of the gut may be warranted, perhaps she’s allergic to chicken and that’s whey she did so poorly.
Heavy metal testing: sometimes heavy metals can trigger all these weird symptoms, and remember that chicken is often loaded with arsenic.
Environmental illness: toxic mold (were there some water leakage problems in her house?) or some other environmental stressor can lead to this seemingly hopeless array of problems, so a work-up by
someone who knows about environmental medicine is warranted.
Yeast: sometimes candida can become systemic and cause lots of weird symptoms, but I don’t recall her having much of an antibiotic history so it depends on the history and presentation.
Other infectious cause: lyme disease can sometimes cause a host of strange problems, and conventional testing isn’t fantastic, so even a trial of therapy could be warranted.

So, perhaps this short list of possible approaches just off the top of my head (I’m away at a conference on integrative treatment of cancer right now so don’t have access to my references) will be helpful for people to understand how I approach things and perhaps they will help this person if she happens upon my website.

Many faces of wheat allergies

The other day I had three patients independently and spontaneously tell me they had discovered they are allergic to wheat.
I've seen a lot of people make huge improvements by removing foods that bother them, and frequently suggest allergy testing or an elimination diet to root out these problems. The interesting thing on this day was the diversity of the symptoms that resolved with removing wheat from these people's diets.
One patient found that when he went off wheat, his thinking became much clearer (he's been diagnosed with bipolar disorder and attention deficit) and he stopped using the lithium he had been prescribed since he didn't need it any more. In addition, his chronic runny nose and reflux symptoms went away, problems he was having with dry skin on his face resolved, he lost weight and he's performing much better at work. Upon re-challenge with wheat, he started getting a dry rash on his face which resolved with avoiding wheat again.
Another patient found that his chronic eczema and hives improved when he stopped eating wheat.
The third patient eliminated wheat and this was the only thing that improved her intense sugar cravings that had originally brought her in. She also found an improvement in her energy levels and that re-challenge with wheat makes her feel terrible and gives her a runny nose, canker sores and fatigue.
Unfortunately, I don't have consistent testing between these three people due to individual circumstances and finances. Gliadin antibodies (from conventional labs) on all three were negative (gliadin is one part of the gluten protein that can trigger gut reactions). IgG and IgE antibodies (through a conventional lab) on one patient showed moderate IgE antibodies to wheat (this is characteristic of eczema) and very low IgG antibodies to wheat. One patient had a combined IgE/IgG4 antibody test through a specialty lab that did show high levels of antibodies to wheat and gluten. I have had other patients who didn't turn up any positives to conventional IgG/IgE testing despite profound symptoms that improved with removing wheat.
On the heels of this, an article came out in
American Family Physician (a journal for family docs) that maintains the doctrine that only IgE mediated reactions (which can be elicited with skin-prick testing) are food allergies and that most things that are called food allergies aren't. While that may satisfy allergists (for whom skin-prick testing is a significant part of their office income), it does little for the patients who have sensitivities to foods that don't show up on skin testing, and they are often dismissed by physicians who don't know that there is more to it than just IgE reactions. Some of the early work on food allergies was done by allergists, but the specialty has veered over to simple skin testing (which rarely shows food allergies) as the standard for allergy testing, leaving all the patients who don't show up with it out in the cold.

Why, oh why, Wyeth?

Fireworks tomorrow, 31 days early!
In case you haven't heard, Wyeth, the maker of Premarin and Prempro (Premarin + Provera), has been plotting to maintain their marketshare by restricting women's freedom to choose safer medications for themselves. Ever since the Women's Health Initiative revealed in 2002 that Prempro increased the risk of stroke, breast cancer, heart attacks, and blood clots (a finding that I, in residency at the time, thought was obvious since Provera was well known to increase the risk of clots), Wyeth has been struggling to maintain its sales of these patent medicines.
Wyeth has managed to keep a monopoly on PREgnant MARe urINe (PREMARIN, get it?) products in the US since it was introduced in 1942 by
dubious legal and political maneuvers including using at least seven women's advocacy groups it funded to influence congressional hearings in 1995. By maintaining this stranglehold on relief of menopausal symptoms, Wyeth has extended its dominion well past the 20 year patent protection and in 2001 had over 11 million women using its hormone medications and over $2 billion in sales of those medications. Following the revelations of the Women's Health Initiative, sales of Premarin and Prempro drop and by 2006 sales are half of 2001 levels (though they had dipped even lower before Wyeth made lower strength versions and pushed for more prescribing).
As women flock to safer treatments like bioidentical hormone replacement (using hormones identical to the ones originally in the women's body), Wyeth decides to protect its profits at the expense of women seeking relief of menopausal symptoms and preventing other changes related to loss of estrogen like osteoporosis and memory loss. In 2005, Wyeth files a "citizen's petition" with the FDA that pushes the FDA to ban estriol, an estrogen naturally produced by women, as an unapproved new drug. Within 70 days, 11 organizations, mostly funded by Wyeth (in a stunning repeat of their tactics 63 years earlier), submit letters of support for this petition. Again, May 19, 2008, members of congress received a letter (coordinated by Wyeth) from 14 organizations (all with major funding from Wyeth) supporting the FDA's actions.
Besides estriol having a 50 year history of use and listing in the US Pharmacopeia, it was in the precursor to Premarin (that was made from pregnant women's urine- but it proved too difficult to collect), and is used by Wyeth itself in products sold overseas. Recent research has shown estriol may reduce the risk of breast cancer and be beneficial in treating multiple sclerosis.
This year, in response to Wyeth's petition, the FDA bans the use of estriol (though the FDA does not have jurisdiction over compounding pharmacies, so this is also a power grab by the FDA) despite admitting that there have been no reports of adverse events associated with its use ever. Somehow, the FDA has managed to put an import restriction on estriol as well, so even though compounding pharmacies shouldn't be subject to the FDA's decrees they are having trouble getting supplies of estriol. Under the FDA's plan, it would require a physician to file an Investigational New Drug form (with the associated $50,000 fee to the FDA) to order estriol for patients.
In the end,
women are losing their options so Wyeth can make more profits.
So, what's with the fireworks? Well, Tuesday, June 3, is the day that hundreds of compounding pharmacists will descend on capitol hill to support H. Con. Res. 342 at the same time the
AAHF is delivering independent letters of support, and a full page ad will appear in Roll Call.
Learn more about this issue
here, and learn more about estriol specifically here.
Corporations will only be able to get away with this as long as we remain quiet, so speak up for this and get active in politics: corporations pay big money to bend the laws in the direction of increased profits whatever the human cost, so the humans have to speak up. It's time.

Dr. Wright joins the fray!

Yikes! I just found out that Dr. Jonathan Wright has joined up as the 11th speaker for the BHRT World Summit that starts tomorrow. Now there's no excuse not to listen in! Also, they've relaxed the listening constraints for the $10 option so you have more flexibility about when you listen.

Bioidentical Hormone Replacement Therapy World Summit

I just found out there's an interesting series of audio conferences coming up: the BHRT World Summit. It starts May 14 and runs through June 2. Lots of doctors who use bio-identical hormones are lined up for this, though I've only heard of a few of them. Sadly, my favorite BHRT guru, Jonathan Wright MD, isn't on the slate.
It does look promising. I'll check it out myself, too, even though it's aimed at regular people. They'll let you listen in each evening for only $10 for the whole series. They also have additional options to listen to the interviews, either by listening on your own schedule or even getting CDs and text from the interviews.
BHRT World Summit
Yes, I know the banner says it ends May 29, but they've added more interviews, so it's an even better deal.

Crohn's costs

I just came across an article about a lottery in Oregon for covering healthcare expenses. The woman mentioned in the story is $15,000 in debt from the year's treatment of her Crohn's disease.
I've learned of a natural therapy for Crohn's disease that achieved remission in 62% of patients and improvement in 76%, much better than conventional medicine. When I initially looked into it, I thought it was expensive, with a standard first course of therapy costing in the neighborhood of $4000, but now I see that is substantially less than then conventional treatment and with much better outcomes. The treatment does seem a
bit odd, but the science makes sense and it seems to work. The duration of remission is longer the younger people are, with the elderly maintaining remissions up to 2 years.
It seems like it may be helpful in other autoimmune disorders as well (asthma, MS, eczema, psoriasis, food allergies). Time will tell.

Crashing the Airborne plane

I remember the first time I came across Airborne at a regular grocery store. I was a little taken aback that the box was so boldly asserting itself as a "miracle cold buster". I figured that with that tall claim on the outside of the box, they must have some good data to back it up or they'd be eating their words.
Turns out they are eating their words for this advertising: they are offering refunds to people who bought it between May 2001 and November 2007 as part of a
settlement for false advertising.
When I first saw Airborne, a quick look at the nutrition facts showed it had some reasonable stuff in it: a gram of vitamin C, a good bit of vitamin A, and a smattering of other nutrients and herbs. While the mix of nutrients seemed OK, I noticed that it has mineral oil (a petroleum product) as an ingredient and wasn't eager to buy it since. Later, my wife brought a tube of it home and I had a opportunity to look at the
ingredients a little more closely. Besides mineral oil, it also has sucralose (the same stuff that's in Splenda), an artificial sweetener that may have some health effects. Not something I' d eagerly put in my body nor would I recommend it to others.
If they're making poor judgements about the non-nutritional ingredients in the product, why should I trust them about the nutritional ones (remembering that there is virtually no oversight of nutritional products: the FDA only looks into them if there is a complaint, and (besides being chronically underfunded) is too busy harassing (at the behest of
Wyeth) compounding pharmacies for using a safe naturally occurring hormone in hormone preparations to do anything useful)? Seems like a good reason to get a refund for the tube that we've barely touched.
An interesting side note (in case I haven't made enough already) is whether this offering refunds really means anything since the tube already declares "100% Guaranteed Satisfaction", so they'd be potentially giving refunds to anyone who wants one already. Once again, the consumer gets precious little while the lawyers get a big chunk of the $23.3 million settlement.

Integrative Pediatrician new in town

I had the pleasure the other night of having dinner with Richard Linsk MD, a pediatrician who has recently opened an office here in Ann Arbor on south Main street. He's focusing on the treatment of autism and ASD, and does general pediatrics. He used to be in the University of Michigan health system, but as he started doing more treatment of autism he invoked the ire of the systems' autism "specialists" (who don't seem to do much more then sedate the kids) and has had to branch out on his own.
In talking with him that evening, I came to appreciate his tremendous honesty. Not only is he honest about his own limitations (an unusual feat in most doctors), but his honest perception of the shortcomings of conventional treatment are what drove him to expand into functional medicine and other modalities.
During dinner, I realized that he was one of the pediatricians I had rotated with in medical school (over 8 years ago). He was working out of a small building with a couple other pediatricians and I ended up spending most of my time there with him. Something about him made me think I had the most to learn from him, and in retrospect I think some of it was his willingness to seek the truth despite the pressure of being harried with a full (over) load of patients and those annoying medical students.
In addition to his regular office visits, he offers HBOT in roomy chambers (that you can rent out) and single-reagent immunizations. His website is
www.integrativepediatrics.net.

It's raining lead!

It seems like the cascade of lead in products on our store shelves never ends: paint, toys from China, lunch boxes, supplements from China. Now we've got another source of lead coming from right here in this country: lipstick. Of the name-brand lipsticks tested over half had significant levels of lead and a third of the lipsticks had more lead than is currently allowed to be in candy (I didn't realize they allow lead in candy...). You can read the full report here.
So, add this to the pile of sources of lead exposure and stir it with the
research that came out last year showing that lead exposure at levels way below what was considered toxic increased heart attacks. How many other things does it impact? No one's done the research.
The best thing to do is protect yourself by minimizing your exposure, taking plenty of vitamin C and consider removing what lead there is with
proven chelating agents.

Vitamin D (again) reduces cancer risk

It's starting to get tedious. In a recent article in the American Journal of Clinical Nutrition, Vitamin D (this time with calcium) reduces the risk of cancer (in a group of >55 year old Nebraskans) over a 4 year period by 76% (95% confidence interval 40-91%). At least they gave a useful amount of vitamin D3 (1100iu/day). Interestingly, even calcium (1500mg/day) alone showed a substantial lowering of risk, but it wasn't significant.
Now, the important thing to appreciate is that this study was only 4 years and that your typical cancer will have been growing for several years before it is diagnosed. So, is this a reduction in the incidence of cancers (less cancers starting), slowing of growth (thus fewer showing up over the study), or stopping the cancers that had already begun? Frankly, with such a dramatic improvement, it could be all three.

Phthalates, testosterone, air freshener, and fish

What do phthalates, testosterone, air freshener, and fish have in common? They've all been topics in recent articles coming from the NRDC's senior scientist Gina Soloman. Nice source of information.
The first three all come form the same article:
Air Fresheners - How Safe Are They? NRDC tested 14 air fresheners and found 12 contained phthalates, which are endocrine disrupters and alter hormone levels - particularly the testosterone levels in babies. Walgreens, whose air fresheners had the most phthalates, impressively responded by pulling the stuff off the shelf and reformulating it. Here's a page that lists the symptoms many perfume ingredients can cause as well as other things you can use to clean, and this page summarizes the phthalates issue and also tells you what you can do about it.
The
other article discusses the conflicting recommendations that just came out about fish intake particularly for pregnant women. She correctly points out that the recommendations to eat fish should include aiming for low-mercury fish. At the end of the article she has several great links about the issues at play.

"Pharmacologic Treatment of Osteopenia Not Usually Indicated"

A recent American Family Physician journal, citing a JAMA article, puts the lie to the idea that people (particularly women) with osteopenia (low bone density) should be on medications. With all the evidence that these medications (like Fosamax or its friends) shouldn't be first-line treatments, why are doctors still prescribing them so quickly? If your doctor pulls out the pad for this, ask them when the last time they saw that drug rep and whether they are pushing the doc to use it as a preventative. This kind of behavior is occurring more and more, so let your doctor know that it's getting so obvious and blatant that even the patients are picking up on it. There are some movement among conventional docs to limit their exposure to drug reps, No Free Lunch for practicing physicians and Pharmfree for medical students. Sadly, the No Free Lunch doesn't turn up any drug-rep free primary care physicians in Ann Arbor (though it does find a pediatrician in Ypsilanti).
Interestingly, the article points out that the
only treatment that has been shown to reduce nonvertebral fracture risk in women with osteopenia is estrogen. Bioidenticals, anyone?

Yield or flavor and nutrition?

When I was in college, I brought my grandmother an organic nectarine from the co-op in Champaign. She wasn't interested, saying, "I don't like nectarines," but finally acquiesced. When she tried it, her eyes lit up and she said she didn't like the ones in the stores any more since they were flavorless, but this one tasted like they did when she was a kid.
A
nice report just came out that puts together the increase in yield through modern farming with the loss of flavor and nutrients that has been dogging our foods. The bottom line is that while the volume of food per acre has increased, the nutrients per acre has not seen the same increase, so the food is less nutritious. Along with the loss of nutrition comes a loss of flavor (is it because of this that people are thought to lose their sense of taste as they get older?).
There's lots of great info in the
full report, but it's 36 pages plus introduction and footnotes, so let me hit a couple important points:

•At least 30% "of the U.S. population ingests inadequate levels [by their estimation of "average requirement"] of magnesium, vitamin C, vitamin E, and vitamin A". This also means "the average American consumes inadequate levels of 2.9 [of the 16 evaluated] essential nutrients each day". This is worse in women and worse with increasing age (women 19-30 years old average 3.78 deficiencies, nearly 1/4 of the nutrients studied). Specifically, vitamin E intake is inadequate in over 97% of adult women, with the average getting only half of what she needs (note that this is vitamin E from food which is more then just the alpha-tocopherol found in most supplements). [p. 8]
•By growing new, high-yield, varieties next to older varieties, they were able to demonstrate that the significant reductions in modern crops stems from the high-yield strains: between strains used in 1873 and 2000, iron dropped by 28%, zinc dropped by 34% and selenium dropped by 36%, in addition to a decrease in the quality of the protein. This means you must eat more food to get the same amounts of nutrients. [p. 14]
•This doesn't only apply to vegetables, but to other foods as well: as milk production per cow increased, the nutrient concentration decreased. [p. 18]
•The increased transit distance of or food (averaging at least 1,500 miles from farm to plate) means most food is picked green and ripened artificially, further diminishing nutrients: ripe blueberries have more than four times the anthocyanins (cancer-protective compounds) that green picked ones do, and picking apples and apricots green leaves them with no vitamin C, which is normally contained in the ripe fruits. [p. 19]
•Increasing carbon dioxide in the atmosphere also leads to further losses in nutrients. [p. 19]
•Organic foods do have higher concentrations of nutrients that conventionally grown crops. [p. 25]

Finally, they point out that due to the higher nutrient density of organic produce, it scores higher in taste than conventional produce. [p. 32]

Score one for my grandmother.

Insurance companies reject bioidentical hormones!

I just got a note from SaveMyMedicine.org about the latest way that insurance companies are working to help the drug companies: by refusing to pay for compounded hormones. You'd think they'd be smart enough to see that by covering compounded bioidentical hormones they could be saving themselves drastic amounts of money: Premarin or Prometrium are about $45 a month each and testosterone gel or patches are upwards of $200 a month, while compounded estrogen (usually a combination of estrone, estradiol, and estriol), progesterone, or testosterone each start at around $25 or so a month (they can go a little higher at higher doses). Add the additional costs of higher incidences of breast cancer in women taking Provera and they could really be making out by supporting bioidenticals.
Aetna's going to stop on October 1, while BCBS changed their policy back in May (note that BCBS cites an unscientific 2001 FDA study that even the FDA doesn't support).
As the note I got says: If you are an Aetna or BlueCross BlueShield customer, please contact your employer’s HR department and ask them to petition your health insurance company to reinstate coverage of bioidentical hormones and other compounded medicines. Remind them that healthy employees are productive employees and your health depends on these drugs. Your doctor has decided that compounded medicines such as bioidenticals are the best treatment option for you. Both your employer and your insurer have a responsibility to provide you with the medicines you need at a reasonable cost.

The HBOT that just won't stop

Alright, new there's even more stuff I've found on hyperbarics and I hate to keep it to myself. HBOTreatment.com carries a variety of mountains of info on the utility of HBO, including this article (in PDF format) on HBO for multiple sclerosis. In fact, this page is a catalog of articles on using HBO in a variety of disorders.
The
AAHA (American Association for Hyperbaric Awareness) is seeking to advance the understanding of HBOT. Their website is worth a look (just be ready for the audio "Welcome!" when the page loads). The Hyperbaric Healing Institute has a few notes on using HBO for various disorders.

Even more on HBOT!

Would you believe I got an email last night about using hyperbaric oxygen in the military for al the brain injured veterans we're getting these days? It's from the American Association for Health Freedom, who are supporting the International Hyperbaric Medical Association in seeking funding for treatment for 400 veterans. In the background info for the campaign, they include this video of a 17 year old who suffered traumatic brain injury in a high speed motor vehicle accident. After he was discharged from a rehab canter for for failure to improve, he underwent 90 HBOT sessions and made remarkable improvements. An interesting thing to note in this video is that after the first 40 treatments he only makes minimal progression, but then things start improving more quickly.

More on Hyperbarics

Every time I read more on the utility of hyperbaric oxygen (HBOT), I'm more annoyed that it isn't being used more frequently to treat some of the things it's really good at: neurovascular diseases (MS, alzheimer's, etc.), ischemic conditions (stroke, heart attack, sickle cell exacerbations). In addition to the article I mentioned last november, I've come across a couple more: a journal article about the successes of HBOT (and the politics holding it back) and an article about the unrelenting attacks on a physician who is using it to successfully treat patients, as well as an article about the American Heart Association's demonstration that HBOT is an effective treatment for heart attack.
In fact, here's 13 benefits to the heart from HBOT (from that
last article, please see it for the references):
1. Hyperbaric oxygen therapy applied to the heart during critical loss of oxygen exerts a remarkable defibrillating effect so that tremulous, rapid, ineffectual contractions are prevented; total death of the heart muscle cells is avoided; and abnormal dilation of the blood vessels with subsequent complications is controlled.1
2. Using HBOT in conjunction with various drugs enhances the effectiveness of both the oxygen and the drugs.2,3,4,5
3. Combining HBOT with drugs completely arrests or considerably reduces angina attacks in patients otherwise resistant to prolonged drug treatment.6,7,8.9
4. Patients with cardiac pain from ischemic heart disease experience total relief, along with disappearance of dyspnea (difficulty breathing), when they receive HBOT.10,11
5. Administering HBOT lowered elevated blood cholesterol in all 220 patients cited in a study conducted by the Russian internist Dr. S.A. Borukhov and her colleagues.12
6. HBOT normalized electrocardiograms in all patients in that same Soviet study.13
7. For diminished muscular power of the heart, HBO exerts long-term normalizing effects for circulating blood through the body.14
8. HBOT exerts antiarrhythmic action on the heart.15,16,17
9. HBOT increases heart patients' tolerance to hard work and taking on physical loads.18,19
10. HBO taken at three atmospheres of pressure (a pressure rarely used in the United States) protects any individual's heart from damages due to lack of oxygen.20
11. One's entire heart conduction system functions better from receiving HBO treatment (even when prophylactically administered).21
12. Without taking drugs of any kind, breathing oxygen under pressure stabilizes impaired fat metabolism and improves liver function for someone with ischemic heart disease.22
13. Due to its characteristic of mollifying stress and distress, HBO has long-term and short-term protective effects for a person with a heart problem.23


Finally, I just came across a virtual font of articles on HBOT written by
Dr. R. A. Neubauer MD, including 2 articles specifically about the etiology of multiple sclerosis and the treatment of MS with HBOT (1, 2).

Who woulda thought? Folic acid is effective.

After the incessant drumbeat coming out of the pharma-pumped media disparaging nutrition, a refreshing article came out the other day: "Folic Acid May Lower Stroke Risk." One of the key findings is that there are greater improvements in risk in the people who took it longer. This is, of course, obvious, since you can't expect to starve yourself for months then have a good meal and be right back to normal.
Of course, in order not to lose her professorship, dr. Carlsson (who is quoted in the article) has to say that it is premature to recommend a benign and inexpensive nutrient to prevent strokes in the population that shows the greatest reduction in stroke risk from folic acid supplementation (people who've never had strokes, "primary prevention").
Dr. Wang (one of the researchers) suggests that "people in the U.S. who eat healthy diets probably get enough folic acid in the foods they eat." Any guesses what fraction of the population would fall in to that category?

Most Americans obese by 2015?

Epidemiologic Reviews just came out with news that not only are an alarming number of Americans overweight and obese now, over half the American population will be by 2015. They're actually predicting 75% of adults and 24% of children will be overweight or obese.
What can you do to avoid becoming one of them or to leave their ranks? Diet and exercise are simple to say, but not so simple to do. It helps to have support and that why I've started offering First Line Therapy in my office. First Line Therapy is a research based lifestyle program to improve all your risk factors for chronic diseases (including obesity, heart disease, diabetes and more).
Call the office and find out how you can join our First Line Therapy program. We are enrolling more people starting in August.

Catching up with vitamin D

A recent (June 29, 2007) article points out that even in Hawaii, 11.1 hours/week of total body skin exposure (on average) is inadequate to get 51% of the participants to have an adequate amount of vitamin D (which they define as a level of 30 ng/ml, lower than I like). As the lead author states, "This implies that the common clinical recommendation to allow sun exposure to the hands and face for 15 minutes may not ensure vitamin D sufficiency."
This echoes nicely what I've been telling patients for some time based on my own experience of having pale skin, walking to work and taking supplements with 400 iu of vitamin D3 daily and still having a level of only 23: "15 minutes of sun exposure to hands and face daily adequate? A lie. 400 iu daily adequate? A lie."
The article ends with a conservative recommendation of "treating vitamin D deficiency with vitamin D supplementation, "it seems prudent" to aim for a serum 25-hydroxyvitamin D concentration no greater than the maximum produced by natural UV exposure; i.e., approximately 60 ng/mL."
They don't mention that it commonly takes 2,000-4,000 iu daily of D3 to get anywhere near that level, a dose that will give doctors with no nutritional background fecal incontinence. This dose will not get anyone near the lowest toxicity level seen of 150.
So, this article adds to the stack of journal articles supporting higher levels of vitamin D, but will it catch on among conventional docs? Not unless there are vitamin D reps coming in with donuts and pens that say "Vitamin D3" on them. If we're lucky, however, I'm wrong and every doc will start checking vitamin D levels, then recommending adequate vitamin D supplementation (for pennies a day) and cut the rates of cancer and degenerative diseases by huge amounts (some estimates say 50% reduction in cancer with adequate vitamin D).
If you want to learn more about the benefits of vitamin D, the Vitamin D council (
.com or .org) is a good resource.

Challenge to mammography screening before 50.

The American College of Physicians noticed that all those mammograms in younger women may not be a good idea. This article doesn't mention the downsides like compression possibly rupturing tumor capsules or high radiation exposure from mammograms (which increase the risk of breast cancer, particularly in women at high risk). They did also admit that mammograms cannot prevent most breast cancer deaths. So, the final recommendation is that women 40-49 should discuss it with their doctors. If only more doctors knew about alternatives like thermography.

BCBS limiting prescriptions?

I got the Blue Cross "Physician Update" the other day and noticed something alarming. In their quest to reduce expenditures, they are trying to limit what they are spending on prescriptions. Some of the things they are doing are reasonable (using generics where reasonable), but one is disturbing: "Enforcement to Exclude Off-Label Coverage", which "Helps curb prescription drug misuse."
"Off-label use" means using a drug for something other than what the FDA approved it. Keflex (cephalexin) is an antibiotic that has an approved use (the manufacturer did studies to show a benefit for) bacterial infections. There is a common off-label use for preventing bacterial cardiac infections in people who could get them from dental procedures (it is used for this in people who are allergic to penicillin, the usual medication for this).
In addition to the incredibly common off-label prescribing all physicians do, alternative doctors are prone to use things for off-label uses that aren't so common: Omacor (fish oil) for reducing joint pain, Clomid (clomiphene) for increasing low testosterone in men, low-dose naltrexone (LDN) as an immune stimulant in all kinds of diseases (MS, pancreatic cancer, rheumatoid arthritis...), etc. Indeed, it is the innovative use of current medications that drives progress and benefits patients without increasing costs.
Now BCBS seems to be saying that they will know better then the doctor what is appropriate for the patient. Maybe they are the ones practicing medicine without a license?
If you combine this with their threatening to take me off their PPO for "over-utilizing" (spending more than the average 6-15 min appt with patients and getting thorough testing on people), they're not my favorite insurance company right now.

Drug Reps

I've always been uncomfortable with drug reps: they're only there to get doctors to sell their stuff. I caught drug reps misrepresenting stuff in residency: not stuff they could have done by accident. As you may expect, I'm not a big fan of them.
I stumbled across a recent book,
Confessions of an Rx Drug Pusher today and thought I'd share, especially since the posted chapter is pretty damning. Read that chapter here (I linked to the beginning of the chapter, skip all the stuff previous to it). The author is a 15-year veteran of drug sales. The story pretty much speaks for itself.

Hormones and cardiovascular risk

Sometimes I'm disappointed by the journals. Circulation recently had an article on reducing women's risk of cardiovascular risk, in which hormone replacement was listed as class III (not useful/effective, may cause harm). A summary of the article in Medscape breaks down the variation in risk:

Researchers found that "route, type, and dose" of hormone therapy matters, in the Estrogen and Thromboembolism and Risk Study (ESTHER), a multicenter study conducted in 8 hospitals in France that included 271 cases and 610 controls. Compared with nonusers, oral estrogen users had an odds ratio of 4.2 (95% confidence interval [CI], 1.5 - 11.6) and 0.09 [this is probably a typo and the risk should be 0.9] (95% CI, 0.4 - 2.3) for transdermal estrogen. Norpregnane derivatives were linked to a 4-fold increase in venous thromboembolism; but there was no risk for venous thromboembolism with micronized progesterone and pregnane derivatives in the study.


So, there is risk in the standard hormone treatment of oral estrogen and progestins (synthetic progesterone-like molecules): each raises the risk of a clot 4-fold. However, it also shows that transdermal estrogen doesn't increase the risk and may lower it and that progesterone similarly doesn't raise the risk. Using bioidentical hormones in a smart manner, then doesn't raise the risk and likely lowers it going from this article.
Sadly, they also list folic acid and antioxidants in the same class that says "may cause harm". Clearly, no one has died from antioxidants or folic acid. There has been a limited number of studies showing some increase in risk with fractionated antioxidants (beta-carotene or alpha-tocopherol alone) in certain circumstances, so it is important to get use full-spectrum antioxidants when using higher doses (mixed carotenoids with selenium or mixed tocopherols).
Sadly, newspapers often pick up these articles without any background and trumpet it as fact. It pays to read in more depth, and be cautious about people who paint all hormone replacement with the same brush: there are clear differences in risk between approaches, and this is why I do not use oral estrogen at all.

Wrong about echinacea

It looks like I was wrong about echinacea. I had been saying that it is an effective anti-viral and immune-stimulatory herb hat should only be used for 2 weeks at a time. Now, after reading some more definitive research, I see that it is not only OK to take echinacea on a continual basis, but it actually is beneficial to take it this way. Therefore, my old adage that any company that puts echinacea into a daily vitamin doesn't know what they're doing and should be regarded with suspicion is wrong. This is a perfectly reasonable thing to include in a multivitamin, and (as demonstrated in the article on echinacea) may well extend life-spans. The research on mice showed a increase in survival in mice at any age, increasing with the age of the mice.
However, this doesn't mean that any old kind of echinacea will do the trick: other research shows that it is the alkylamides that are responsible for the anti-inflammatory effects and the polysaccharides and glycoproteins are responsible for the immune-stimulating effects, while the echinacosides and other things that OTC echinacea products are typically standardized for don't seem to have much activity, though the phenolic compounds do seem to help
keep the alkylamides from degrading. Also, the dried plant materials lose potency quickly, so good echinacea doesn't come in a powder (unless you take massive amounts).
Also, I finally found the answer for which part of the echinacea (E. Augustifolia seems like the best, and E. Purpurea may be close, but E. Palladia isn't very good) to use when:
Roots harvested in the fall have the anti-inflammatory effects that are good for colds (typically the body will have already eliminated the virus before you start showing symptoms, so the inflammation is just part of the mopping-up process and there is no role for antibiotics at this point especially since colds are caused by a virus which wouldn't be affected by antibiotics even if they were still present despite your doctor having given you antibiotics in the past for a cold - this is an example of bad medicine from listening to too many drug reps and not reading any research or even just about any current literature on treatment of the common cold, but forgive my digression).
When the flowers are in early maturity, the aerial parts contain the immune-strengthening compounds that are good for keeping infections from starting in the first place.

So, I apologize to all the companies I had maligned for putting echinacea in their multivitamins (though they'd better check to see they're putting the right things in there) and especially to everyone who had heard my talks and also had it stuck in their heads the wrong way. It is for them that I am putting this in plain text so we call all get it straight once and for all.

Hyperbaric Oxygen and the "noncovered conditions"

Hyperbaric Oxygen Therapy (HBOT) is quite useful for a number of conditions, though the medicare laws have a curious and unusual statement about HBOT: a non-covered conditions list. Most therapies' entries in the medicare laws don't even list covered conditions, so why does this specifically name 22 conditions as being "non-covered"? This is especially interesting because the 22 conditions are all clearly effectively treated by HBOT.
The last issue of Hyperbaric Medicine Today has an interesting article about how this happened. You can go read it yourself at
http://www.hbomedtoday.com/PDF/HBOMT_8.pdf The article starts on page 7, you'll have to scroll down to it in the acrobat file yourself. Interesting reading.
If you'd like to read some information about HBOT by physicians who use it, try
here. You can read a (relatively) short bibliography of research on HBOT here.

Here is the medicaid list of noncovered conditions:
1. Cutaneous, decubitus, and stasis ulcers
2. Chronic peripheral vascular insufficiency
3. Anaerobic septicemia and infection other than clostridial
4. Skin burns (thermal)
5. Senility
6. Myocardial infarction
7. Cardiogenic shock
8. Sickle cell anemia
9. Acute thermal and chemical pulmonary damage, i.e., smoke inhalation with pulmonary insufficiency
10. Acute or chronic cerebral vascular insufficiency
11. Hepatic necrosis
12. Aerobic septicemia
13. Nonvascular causes of chronic brain syndrome (Pick's disease, Alzheimer's disease, Korsakoff's disease)
14. Tetanus
15. Systemic aerobic infection
16. Organ transplantation.
17. Organ storage.
18. Pulmonary emphysema
19. Exceptional blood loss anemia
20. Multiple Sclerosis
21. Arthritic Diseases
22. Acute cerebral edema

As the author of the "noncovered conditions" list points out, there is no law against using HBOT for these conditions, they are merely off-label uses for HBOT. There are also articles about using HBOT for
migraine and Lyme disease (which medicare presumably won't cover either, nor, by extension, would insurance companies). And since I have a special interest in MS, I dug up this page which is the beginning of a discussion on HBOT for MS.

Why do I take this interest in HBOT? I managed to get my hands on a modest chamber and have been looking into using it therapeutically.

Bad reporting on flawed studies

Thorne Research came out with an editorial that nicely summarizes the problems with some of the recent, well publicized, studies that can be construed to show that supplements are ineffective. However, looking at the actual studies clearly shows they do work. For the full story, read the article.

Perchlorate/thyroid and lead/circulation connections

Nice articles further substantiating the environmental connections to thyroid and heart disease/stroke came out recently. I added the links in the "useful health resources" section of the Links page.

New links

While writing an email on a list for med students I came across some interesting links that I added to the Links page.