You Know You're Living in [2010] when...

1. You accidentally enter your PIN on the microwave.

2. You haven't played solitaire with real cards in years.

3. You have a list of 15 phone numbers to reach your family of three.

4. You e-mail the person who works at the desk next to you.

5. Your reason for not staying in touch with friends and family is that they don't have e-mail addresses.

6. You pull up in your own driveway and use your cell phone to see if anyone is home to help you carry in the groceries.

7. Every commercial  on television has a web site at the bottom of the screen.

8. Leaving the house  without your cell phone, which you didn't even have the first 20 or 30 (or 60) years of your life, is now a cause for panic and you turn around to go and get it.

10. You get up in the morning and go on line before getting your coffee.

11. You start tilting your head sideways to smile. : )

12 You're reading this and nodding and laughing.

13. Even worse, you know exactly to whom you are going to forward this message.

14. You are too busy to notice there was no #9 on this list.

15. You actually scrolled back up to check that there wasn't a #9 on this list.

NOW U R LAUGHING at yourself!

Author Unknown

Adapted / Posted by: Scott W. Yates, MD, MBA, MS, FACP

Phys Ed: Can Vitamin D Improve Your Athletic Performance?

When scientists at the Australian Institute of Sport recently decided to check the Vitamin D status of some of that country’s elite female gymnasts, their findings were fairly alarming. Of the 18 gymnasts tested, 15 had levels that were “below current recommended guidelines for optimal bone health,” the study’s authors report. Six of these had Vitamin D levels that would qualify as medically deficient. Unlike other nutrients, Vitamin D can be obtained by exposure to ultraviolet radiation from sunlight, as well as through foods or supplements. Of course, female gymnasts are a unique and specialized bunch, not known for the quality or quantity of their diets, or for getting outside much.

But in another study presented at a conference earlier this year, researchers found that many of a group of distance runners also had poor Vitamin D status. Forty percent of the runners, who trained outdoors in sunny Baton Rouge, Louisiana, had insufficient Vitamin D. “It was something of a surprise,” says D. Enette Larson-Meyer, an assistant professor in the Department of Family and Consumer Sciences at the University of Wyoming and one of the authors of the study.

Vitamin D is an often overlooked element in athletic achievement, a “sleeper nutrient,” says John Anderson, a professor emeritus of nutrition at the University of North Carolina and one of the authors of a review article published online in May about Vitamin D and athletic performance. Vitamin D once was thought to be primarily involved in bone development. But a growing body of research suggests that it’s vital in multiple different bodily functions, including allowing body cells to utilize calcium (which is essential for cell metabolism), muscle fibers to develop and grow normally, and the immune system to function properly. “Almost every cell in the body has receptors” for Vitamin D, Anderson says. “It can up-regulate and down-regulate hundreds, maybe even thousands of genes,” Larson-Meyer says. “We’re only at the start of understanding how important it is.”

But many of us, it seems, no matter how active and scrupulous we are about health, don’t get enough Vitamin D. Nowadays, “many people aren’t going outside very much,” Johnson says, and most of us assiduously apply sunscreen and take other precautions when we do. The Baton Rouge runners, for instance, most likely “ran early in the morning or late in the day,” Larson-Meyer says, reducing their chances of heat stroke or sunburn, but also reducing their exposure to sunlight.

Meanwhile, dietary sources of Vitamin D are meager. Cod-liver oil provides a whopping dose. But a glass of fortified milk provides a fraction of what scientists now think we need per day. (A major study published online in the journal Pediatrics last month concluded that more than 60 percent of American children, or almost 51 million kids, have “insufficient” levels of Vitamin D and another 9 percent, or 7.6 million children, are clinically “deficient,” a serious condition. Cases of childhood rickets, a bone disease caused by lack of Vitamin D, have been rising in the U.S. in recent years.)

Although few studies have looked closely at the issue of Vitamin D and athletic performance, those that have are suggestive. A series of strange but evocative studies undertaken decades ago in Russia and Germany, for instance, hint that the Eastern Bloc nations may have depended in part on sunlamps and Vitamin D to produce their preternaturally well-muscled and world-beating athletes. In one of the studies, four Russian sprinters were doused with artificial, ultraviolet light. Another group wasn’t. Both trained identically for the 100-meter dash. The control group lowered their sprint times by 1.7 percent. The radiated runners, in comparison, improved by an impressive 7.4 percent.

More recently, when researchers tested the vertical jumping ability of a small group of adolescent athletes, Larson-Meyer says, “they found that those who had the lowest levels of Vitamin D tended not to jump as high,” intimating that too little of the nutrient may impair muscle power. Low levels might also contribute to sports injuries, in part because Vitamin D is so important for bone and muscle health. In a Creighton University study of female naval recruits, stress fractures were reduced significantly after the women started taking supplements of Vitamin D and calcium.

A number of recent studies also have shown that, among athletes who train outside year-round, maximal oxygen intake tends to be highest in late summer, Johnson says. The athletes, in other words, are fittest in August, when ultraviolet radiation from the sun is near its zenith. They often then experience an abrupt drop in maximal oxygen intake, beginning as early as September, even thought they continue to train just as hard. This decline coincides with the autumnal lengthening of the angle of sunlight. Less ultraviolet radiation reaches the earth and, apparently, sports performance suffers.

Concerned now about your Vitamin D status? You can learn your status with a simple blood test. An at-home version is available through the Web site of the Vitamin D Council. (Use of the tests is restricted in some states, including New York. See the website for details.) Be sure that any test checks the level of 25(OH)D in your blood. This level “should generally be above 50 nanograms per milliliter,” Larson-Meyer says.

If your levels are low, talk to your doctor about the best response. Sunlight is one easy, if controversial, fix. “Most dermatologists will still tell you that no amount of sun exposure is safe,” Johnson says.

But Larson-Meyer and other Vitamin D researchers aren’t so sure. “There’s no good, scientific evidence that five to thirty minutes of sunlight a few times a week is harmful,” she says.

Or try supplements. “1,000 IU a day and much more for people who are deficient” is probably close to ideal, Larson-Meyer says. This, by the way, is about double the current recommended daily allowance. Most experts anticipate that this allowance will be revised upward soon. Consult with your doctor before beginning supplements. Overdoses of Vitamin D are rare, but can occur.

Finally, stay tuned. “In the next few years, we’re going to be learning much more” about the role of vitamin D in bodily function and sports performance, Larson-Meyer says.

From The New York Times by Gretchen Reynolds

Reviewed / Posted by: Scott W. Yates, MD, MBA, MS, FACP

Robert Frost

"Two roads diverged in a wood, and I -
I took the one less traveled by,
And that has made all the difference."

-- Robert Frost (1874 - 1963)

Getting Well: It's About Time

What cures colds, flu, sore throats, sore muscles, headaches, stomach aches, diarrhea, menstrual cramps, hangovers, back pain, jaw pain, tennis elbow, blisters, acne and colic, costs nothing, has no weird side effects and doesn't require a prescription?

Plain old-fashioned time. But it's often the hardest medicine for patients to take.

"Most people's bodies and immune systems are wonderful in terms of handling things-if people can be patient," says Ted Epperly, a family physician in Boise, Idaho, and president of the American Academy of Family Physicians.  "I have a mantra: You can do more for yourself than I can do for you," says Raymond Scalettar, a Washington, D.C., rheumatologist and former chairman of the American Medical Association. But, he says, "some patients are very medicine-oriented, and when you tell them they aren't good candidates for a drug they've heard about on TV, they don't come back." 

An estimated one-third to one-half of the $2.2 trillion Americans spend annually on health care in the U.S. is spent on unnecessary tests, treatments and doctor visits. Much of that merely buys time for the body to heal itself.  And while temporary relief from symptoms is nothing to sneeze at, it adds up to a considerable amount of spending: $5.4 billion annually on cough and cold remedies, $2.7 billion on headache remedies and $411 million on chest rubs and other analgesics, according to Nielsen Co. Americans also spend an estimated $1 billion on unnecessary antibiotics that don't even relieve the symptoms of viral infections, and contribute to antibiotic resistance. But some patients are so insistent on getting antibiotics that doctors give in.

"I have colleagues who say, 'You can take this pill and get better in two days, or do nothing and get over it in 48 hours,' " says Dr. Scalettar.  Even H1N1, or swine flu, for all the uproar, almost always resolves in a few days with no treatment. The Centers for Disease Control and
Prevention is urging physicians to use Tamiflu, an antiviral medication, sparingly to prevent shortages and avoid antiviral resistance. Only people who are hospitalized or at high risk for complications should get Tamiflu, according to the CDC.

The list of "self limiting" maladies-those that require no outside treatment-range from minor annoyances to what might appear to be more serious musculoskeletal problems. "Muscle aches and pain, minor traumas, sprains and strains typically do not need to be seen by a doctor," says Dr. Epperly, who recommends his organization's Web site, www.FamilyDoctor.org, as a resource to look up symptoms and health concerns. "Nausea, vomiting and diarrhea are typically time-limited.  People will start to see improvement in two or three days-just watch that you're not throwing up blood," he says. If so, call your doctor. Almost all viral infections resolve on their own, unless you have a compromised immune system. As a rule of thumb, Dr. Epperly says, infections in the nose, throat, stomach and upper respiratory tract tend to be viral. Infections elsewhere in the body are likely to be caused by bacteria, and those can get worse without antibiotics. About 80% of urinary-tract infections resolve on their own, for example, but about 20% develop into more serious kidney or blood infections. And even if they don't, the symptoms can be very uncomfortable.

Parents are often extremely eager to "do something" for children who complain of sniffles, stomach aches, scrapes and fevers. Yet kids are generally very resilient, writes Lara Zibners, an emergency pediatrician, in her book, "If Your Kid Eats This Book, Everything Will Still Be Okay." (For a fever, she advises calling the doctor if the patient is a baby younger than three months and has a fever over 100.4 degrees. For kids older than that, other symptoms are more important than the thermometer-especially if a child is listless, irritable, unusually sleepy, refusing to eat or drink, or having trouble breathing.) Some chronic maladies follow predictable courses, according to many medical experts ,whether or not they are treated. Colic is almost always gone in four months. Some 70% of acne is gone three to four years after it first appears. "Frozen shoulder"-a painful restriction of the shoulder joint-is typically painful for three to six months and stiff for the next four to six months, and resolves completely after one to three more months. Temporomandibular joint (TMJ) pain tends to go away by itself in 18 months. Sciatica resolves on its own in three weeks in 75% of cases.

For all the misery it causes, 80% to 90% of back pain resolves with only "conservative measures" (which include anti-inflammatory drugs, rest, heat, physical therapy and chiropractic treatments). "Sometimes it take days to weeks, sometimes it takes weeks to months, but pain lasts more than three months in only about 10% of cases," says Michael J. Yaszemski, chief of orthopedic spine surgery at the Mayo Clinic in Rochester, Minn.  Whether to operate even in those remaining cases is controversial, he says. With acute lumbar disc herniation, studies have found that two and five years later, there's little difference between patients who had surgery and those who did not. But surgery can sometimes provide relief faster.

"There are those patients who feel they just can't wait-like Joe Montana," says Dr. Yaszemski of the former San Francisco 49ers quarterback, who made headlines when he returned to playing football just eight weeks after spinal surgery in 1986.  Many patients are relieved to hear that they don't need to take medicine, have a blood test or undergo surgery for what ails them. But some feel embarrassed to have taken the doctor's time or frustrated because they think the doctor isn't taking their situation seriously. ("Much depends on the way you tell them," says Dr. Scalettar. "There are some arrogant doctors.")

And some patients resent paying for a visit when all the doctor provides is reassurance that they'll get better with time. "If a patient says, 'You mean, I'm paying $100 for you to tell me there's nothing wrong?' I say, 'There is something wrong-a virus,' " says Dr. Epperly. " 'But more  importantly, I can tell you what's not wrong: it's not meningitis or cancer or a brain tumor or some other life-threatening illness. And if the pain doesn't go away in a few days, please, please tell me, and we'll investigate further.' " "The longer you've known someone, the easier that conversation is," Dr. Epperly adds. Indeed, applying what some call "a tincture of time" requires time on the doctor's part as well. Explaining why a medication or CT scan or MRI isn't necessary, or what signs to look for if an ailment isn't getting better, often takes more time than writing a quick prescription. Of course, there are symptoms that people should never ignore, since they could signal a serious illness or a condition that could get worse, not better, with time.

Contact your doctor immediately if you experience any of the following:

- Crushing chest pains-the classic signs of a possible heart attack.
- Sudden numbness or weakness on one side of the body, confusion, trouble speaking or severe headache-which could indicate a stroke.
- Sudden, severe headaches.
- Any major injury, especially involving loss of consciousness.
- Coughing up, throwing up or excreting blood.
- Suicidal or homicidal urges.
- Flashing lights in your vision-which could be a detached retina.

- Inability to breath-which could be a severe allergic reaction.
- Recurrent tooth pain. "You can typically give a tooth ache 24 hours," says Dr. Epperly. "If it's an abscess that would require a root canal, it won't get better by itself."

The bottom line: Don't hesitate to call your doctor if you have persistent pain or a loss of function or anything unusual for you. It's worthwhile to rule out something serious that does need medical attention. But if the doctor says you will get better on your own, that's a powerful prescription itself.

From The Wall Street Journal, by Melinda Beck

Reviewed / Posted by: Scott W. Yates, MD, MBA, MS, FACP

"The good physician treats the disease; the great physician treats the patient who has the disease."

-- Sir William Osler

Vaccines are not just for children any more

"Vaccines are not just for children any more."

That is the important, and potentially life-saving message, that Geisinger Health System pediatric gastroenterologist William Cochran, M.D., vice chairman of the Janet Weis Children's Hospital, wants to deliver. And this is a message that comes from personal experience. "I am a physician, and I didn't realize that adults needed to be revaccinated for what are considered childhood diseases such as pertussis  (whooping cough)," said Dr. Cochran. "And I found that out the hard way by contracting that very disease."

According to the Centers for Disease Control and Prevention, pertussis is an acute, infectious cough illness that remains prevalent in the United States despite longstanding routine childhood pertussis vaccination. It is characterized by the unforgettable "whoop" sound made when gasping for breath after a coughing fit. It creates a sticky, thick mucous that makes it difficult to eat, drink and breathe. This remains an issue because immunity wanes approximately five to 10 years after completion of childhood vaccination, leaving adolescents and adults susceptible to the disease. The CDC reports that since the 1980s, the number of reported pertussis cases has increased steadily, especially among adolescents and adults. And, between 2000-2003 and 2004-2007, there was a 100-percent increase in reported cases of pertussis; there may be as many as 800,000 to 3.3 million adult and adolescent cases of pertussis in any given year.

"This is considered the 100-day cough," said Lisa Esolen, M.D., system director of Geisinger Infection Control. "This is not a cough that goes away after a few days. At Geisinger alone, we've had two pertussis outbreaks within a span of a year, one of which required delivering antibiotics to 105 people who were exposed. That is a significant number. And all it takes is awareness and revaccination to control."  Dr. Cochran's experience with the disease, and lengthy and painful recovery, has inspired him to educate adults about the importance of revaccination. "The coughing gets so bad that I can't get any air. My airway closes until the 'whoop' end of the cough occurs. It's very frightening and extremely painful," he said. "The CDC recommends that all adults between the ages of 19-64 should be revaccinated, along with healthcare providers. If more adults get their vaccines, then we'll have more power to stop this horrible disease in its tracks."

Source: Geisinger Health System
Reviewed / Posted by: Scott W. Yates, MD, MBA, MS, FACP

What Thomas Jefferson Said

What Thomas Jefferson Said:

"The democracy will cease to exist when you take away from those who are willing to work and give to those who would not."
-- Thomas Jefferson


"It is incumbent on every generation to pay its own debts as it goes.
A principle which if acted on would save one-half the wars of the world."
-- Thomas Jefferson


"I predict future happiness for Americans if they can prevent the government from wasting the labors of the people under the pretense of taking care of them."
-- Thomas Jefferson


"To compel a man to subsidize with his taxes the propagation of ideas which he disbelieves and abhors is sinful and tyrannical."
-- Thomas Jefferson

Heavy Metals, Inc.

Two years ago Ronald Stemp, a plumber from Georgetown, Tex., started having strange symptoms, including forgetfulness, problems concentrating and bouts of depression. His wife became worried that he had been exposed to toxins at work. On the Web she found a place in Austin called Care Clinics that claimed to treat heavy metal poisoning.

The staff there performed a "challenge test" to see if Stemp's urine was positive for heavy metals. During his next visit Stemp consulted with clinic owner Kazuko Curtin. Though not a doctor or a nurse, she wore a white coat and told him that he was indeed suffering from lead and mercury poisoning. She also told Stemp, then 41, that he had Alzheimer's.

Her prescription: 18 months of chelation to remove the toxins. Two to four times a week, Stemp spent four hours hooked to an IV that transfused a chelating chemical. It made him confused and nauseated. He could no longer work. "I was withdrawn from life and family. I was lethargic and dizzy," he recalls. He was billed $180,000 over ten months before he quit a year ago in frustration. He's now suing Care Clinics and its staff for fraud. They deny the allegations.

Chelation is the unproven cure-all that will never die. Developed to remove arsenic from soldiers gassed during World War I, the method is used in mainstream medicine for rare cases of acute heavy metal poisoning. But a renegade group of doctors use it for a far broader range of ills--everything from heart disease to memory impairment--despite scant evidence it works and potentially dangerous side effects. They claim that removing small amounts of metal will resolve the symptoms.

Over the years chelation has been repackaged over and over again. The latest round of easy marks for chelation vendors are parents of children with autism. Some parents are convinced autism is caused by mercury in vaccines, despite many studies to the contrary. Several hundred doctors offer chelation in the autism market, many of them certified by a trade group called the American College for Advancement in Medicine. A 1998 consent decree the group signed with the Federal Trade Commission, in which it agreed to stop making claims about chelation's safety and effectiveness, evidently doesn't get in the doctors' way.

Chelation can be lucrative. A treatment might involve 40 sessions that cost $125 each, usually paid in cash. Various ancillary tests can push the tab above $10,000. Nationally, the chelation market "could be $100 million a year in total billings," estimates Stephen Barrett, a retired psychiatrist who operates QuackWatch.org.

Chelation, from the Greek for "claw," employs amino-acid-based chemicals that latch onto lead, mercury and other metals, allowing the body to more easily excrete them. Medical toxicologists use chelation for cases of serious heavy metal poisoning, such as from industrial accidents.

The American College of Medical Toxicology last summer put out a stern warning about the challenge tests that doctors use to justify chelation on people like Stemp. They test a patient's urine for metals, give a chelating agent, then test the urine again to see if it has more metal. Since everyone has some level of mercury in his blood, it's easy to show what looks like a dramatic problem. "Chelating agents have been found to mobilize metals in healthy individuals," said the statement. The test "has no demonstrated benefit."

Chelation's spread started in the 1950s, when some doctors thought it might be a way to remove the calcified plaque from the arteries of heart patients. But chelating arteries has never been shown to work in trials. In 1989 the Food & Drug Administration included chelation on its list of Top Ten Health Frauds. A 2002 study in the Journal of the American Medical Association compared heart patients who'd been given twice-a-week chelation infusions with those who'd been given a placebo. It found no difference on a treadmill test afterward. Chelation can cause liver and kidney problems; one of the 39 patients getting chelation dropped out after losing kidney function.

"If it worked we would have embraced it a long time ago," says George Todd, a vascular surgeon at St. Luke's-Roosevelt in New York, who says patients "waste time and money" with chelation. He learned the hard way. He once took his autistic son, now 30, to an alternative doctor who gave infusions of chelators. "I should have been suspicious when they said I had to pay $5,000 that day," he says.

In 2003 a study found that chelating agents caused 221 autistic children to expel mercury in their urine. Physicians, using protocols written by a patient group called Defeat Autism Now, soon began offering it. By 2005 an estimated 10,000 autistic children were being chelated.

That year, at the Advanced Integrative Medicine Center near Pittsburgh, a 5-year-old autistic boy from England died when the wrong chelating agent was used. A drop in blood calcium levels led to a heart attack. His doctor was indicted for involuntary manslaughter, but the charges were later dropped. A civil suit is under way. "We do not consider these treatments safe," says Eric Fombonne, a child psychiatrist at McGill University.

David Berger of Wholistic Pediatrics in Tampa chelates 60% of his autism patients and says the procedure is safe when done properly. He sells them a two-month supply of suppositories plus supplements to replace essential minerals. "I take the approach that all kids are heavy-metal-toxic until proven otherwise," Berger says, adding, "I'm open-minded."

The National Institutes of Health helped make chelation respectable in 2002 by starting a $30 million trial of chelation in heart patients as part of a congressional mandate to study alternative remedies; it is ongoing and expected to yield results in 2012. It also initially planned to study chelation for autistic kids but stopped that trial last year before enrolling patients, citing "no clear benefit" to children and "more than a minimal risk."

A 2008 article in the Medscape Journal of Medicine called the heart trial "unethical, dangerous, pointless and wasteful." It counted 30 deaths since the 1970s related to chelation. Retired Stanford professor Wallace Sampson, one of the authors, argues chelation may release metals tied up in tissue into the bloodstream and cause damage where there was none. It also can remove needed minerals.

Allan Magaziner, a family doctor in Cherry Hill, N.J., has chelated heart patients for 23 years and is part of the NIH trial. He says he's prepared to give it up if the trial shows it doesn't work. "That's life. We need to look at things scientifically," he says.

As evidence piles up against a vaccine-autism link, the rationale for giving chelation has shifted toward the notion that people with various diseases are prone to metal toxicity. Promotions for chelation are combined with warnings about lead-contaminated toys and mercury in coal-plant emissions, fish and dental fillings.

As for the plumber Stemp, it isn't clear what caused his original symptoms. But a trained toxicologist found no evidence of heavy metal poisoning. Stemp says he rarely met Care Clinics' Dr. Jesus Caquias, who signed off on all his treatments but who spent much of his time 350 miles away in Brownsville. The Texas Medical Board has twice disciplined Caquias for keeping bad records and making false claims about detoxification treatments. Last July FBI and IRS agents, with a search warrant, raided the Austin clinic and confiscated patient records.

Caquias did not respond to requests for comment. But in his response to Stemp's lawsuit, he said, "Patients have been helped by these treatments" and included letters written on his behalf by patients to the Texas Medical Board. Kazuko Curtin's lawyer, Michael Clark, says that he can't access her records but will vigorously defend her.

From: Forbes Magazine Online by David Whelan
Reviewed / Posted by: Scott W. Yates, MD, MBA, MS, FACP

Are celebrities crossing the line on medical advice?

When first lady Betty Ford announced that she had had a mastectomy in 1974, patient advocates say, it was groundbreaking. Breast-cancer survivors at the time were often afraid to mention their treatment, even to friends.

Today, many people in the public eye, particularly celebrities, feel comfortable sharing their medical problems.  Brooke Shields has acknowledged her postpartum depression. Michael J. Fox has written about his struggle with Parkinson's disease. Elizabeth Taylor updated fans about her heart surgery through Twitter.

Doctors say they can understand why patients sympathize with celebrities and closely follow their battles with serious illnesses.  "It helps people to realize that health problems they have affect even celebrities," says pediatrician Aaron Carroll, director of Indiana University's Center for Health Policy and Professionalism Research.  "Knowing that a rich and famous person can have the same problem as you or me makes it seem more fair, maybe.  "It also can make it easier to talk about your own problem, because a  celebrity has the same issue."  Yet celebrities - who can command huge audiences and sell thousands of books - have a special responsibility to get their facts right, says Bradford Hesse, who studies health communication at the National Cancer Institute. Many doctors say they're troubled by stars who cross the line from sharing their stories to championing questionable or even dangerous medical advice.

 - Tom Cruise in 2005 began a spat with Shields and drew criticism from mental health professionals when he railed against antidepressants and Ritalin on the Today show, dismissing psychiatry as a "pseudoscience."

 - Actress Jenny McCarthy, who has an autistic son, has written several books linking autism with childhood vaccinations, even though a host of scientific studies show that vaccines are safe and not the cause of increasing autism rates.

 - Actress Suzanne Somers- already well-known for her diet books and ThighMaster products - in October released her 18th book, Knockout, which experts describe as a catalogue of unproven or long-debunked alternative cancer "cures."

Re-educating Americans

Doctors and public health groups say they struggle over the best way to respond to celebrity claims.  At Every Child By Two, an immunization campaign co-founded by former first lady Rosalynn Carter, board members were initially inclined to ignore celebrities who question vaccine safety, says executive director Amy Pisani. Now, the group spends 80% of its time explaining why vaccines are still critical. 

"We were poised to start working in Africa," Pisani says. "But we were forced to pull back just to re-educate people here in the United States."

For good or bad, research shows that stars exert powerful influence not just on popular opinion, but on public health.

 - Vaccines. A USA TODAY/Gallup Poll of 1,017 adults found that more than half were aware of McCarthy's warnings about childhood shots. More than 40% of adults familiar with her message - 23% of all adults surveyed say McCarthy's claims have made them more likely to question vaccine safety. The Nov. 20-22 poll had a margin of error of plus or minus 4 percentage points.

 - Colorectal cancer screening. The number of colonoscopies rose 20% in the year after TV news anchor Katie Couric, who lost her husband to the disease, had an on-air screening in 2001, according to a study in the Archivesof Internal Medicine.

 - HIV screening. The number of people being tested for HIV increased after Magic Johnson revealed in 1991 that he had tested positive for the virus, according to a study in New York state.

 - Breast cancer screening. Diagnoses rose slightly in the year after Ford's mastectomy, possibly because more women were motivated to get mammograms, says the American Cancer Society's Otis Brawley.

- Breast cancer surgery. Nancy Reagan's mastectomy in 1987 may have influenced patients' choice of treatment. The number of women getting lumpectomies, instead of more extensive mastectomies, declined 25% in the months after Reagan's surgery, according to a study in The Journal of the American Medical Association.

Celebrities have the power to do tremendous good, Hesse says. Lance Armstrong, who survived testicular cancer, has advocated for funding and policy changes to help cancer patients and has raised more than $325 million through his foundation.  "People like Katie Couric and Lance Armstrong can do a lot to teach people that it is important to talk to their doctors about screening for cancer," Hesse says. "Some would say they have done more for the cause of public awareness for cancer than most scientists."  Yet celebrities also can spread misinformation much faster than the average person with a wacky theory, Hesse says.  Correcting that misinformation - even with a mountain of evidence - can be a challenge, says Paul Offit, chief of infectious diseases at Children's Hospital of Philadelphia. "It's much easier to scare people than to unscare them," Offit says. 

By swaying parents to delay or reject childhood vaccines, celebrities could undermine efforts to protect  newborns and other vulnerable children from devastating diseases, says pediatrician Martin Myers, executive director of the National Network for Immunization Information.  "I worry about these celebrities who confuse people," Myers says. "I don't think they know how much damage they can cause." 

'The University of Google'

Some psychologists say that celebrity activists are part of a larger trend, in which survivors of serious illness feel less of a stigma about speaking out and find it therapeutic to help others in a similar situation. "Giving to other people has a profound way of rewarding us," says the NCI's Julia Rowland. "It's a way to make meaning out of a situation.. .. You tell other people how to cope, and it helps you cope, too."  Others note that celebrities give voice to frustrations shared by many Americans.

"If someone has a heartfelt belief that something ought to be on the radar screen of America, they ought to put it out there, because believe me, other people are saying it anyway," says Mehmet Oz, a heart surgeon and host of The Dr. Oz Show. "I'd rather have it come up publicly and have Larry King have a debate about it."  Studies show that doctors still have great influence. About 68% of people trust their doctors "a lot," according to a 2007 survey by the NCI, giving them higher ratings than any other source, such as family, friends, the government, the Internet or other media.  In a televised debate, however, Oz says that a telegenic actor has a natural advantage over bespectacled scientists, however well-meaning and knowledgeable. Yet personal testimonies, however compelling, also can be misleading, says Offit, who helped develop a vaccine against a deadly infection called rotavirus. 

As a patient or parent, "you know about your particular situation, but that doesn't make you an expert in the field," Offit says. "It's part of our culture now. We believe we can be experts by simply looking on the Internet."

In her book Mother Warriors, McCarthy, who declined to be interviewed for this story, says she learned about autism from "the university of Google."  Explaining complex science - especially in the few minutes allotted on a TV program - is challenging, Carroll says.  Audiences sympathize with McCarthy, who says she doesn't need science because she observes her son, Evan, every day. "At home," she writes, "Evan is my science."  "How can you argue with that?" Carroll asks. "It's her child. It's her body. They win."  That's why Pisani says she urges parents to speak out about the need for vaccines. Actress Amanda Peet now works with vaccine groups, encouraging parents to get their medical advice from doctors, rather than celebrities like herself.

Oz says doctors must do a better job of putting a human face on medical questions while showing that they take people's concerns seriously. "Ten percent of people are going to believe in Suzanne Somers anyway,"  Oz says. "What I don't want is to have 50% more people go there." Alternative cancer treatments that, experts say, have been debunked for years.

By Liz Szabo, USA TODAY
Reviewed / Posted by: Scott W. Yates, MD, MBA, MS, FACP

Just When You Thought it Was Over

Health officials in Dallas and Tarrant counties have announced additional H1N1 influenza deaths. Recent victims include a 29-year-old in Dallas County, a 28-year-old in Collin County and in Tarrant County a two-year-old toddler and a man in his 60's.  The latter two victims were previously healthy.

While H1N1 disease is waning overall, these latest death should serve as a clear reminder to continue vaccination. The H1N1 vaccine is no different than the seasonal flu vaccine produced each fall and it's extremely safe.  If you've not had the vaccine, you should.

Posted by: Scott W. Yates, MD, MBA, MS, FACP

The Evidence On Ginkgo Biloba and Memory

Medical research is finally starting to catch up with millions of Americans who have been taking vitamins and supplements for years. But people who swear by their pills to stay fit and sharp may not like the evidence that’s starting to accumulate.

The latest comes from a federally funded study of ginkgo biloba, a supplement widely used to improve memory and other cognitive functions. More than 3,000 people between the ages of 72 and 96 were randomly assigned to take a placebo or 120 mg of ginkgo twice a day. None of the patients had dementia when the study began, and they were followed for a median of just over six years. 

Those who took ginkgo fared no better than those who took placebo on a battery of tests that examined memory, language, attention and other measures of cognitive function. The results are published in this week’s JAMA; an earlier analysis of the same study also found that ginkgo didn’t reduce the risk of Alzheimer’s.

As this New York Times column noted earlier this year, several big studies in the past few years have suggested that certain vitamins pills and other supplements don’t improve key health outcomes.

“I’m puzzled why the public in general ignores the results of well-done trials,” one doc who has studied this stuff told the NYT. “The public’s belief in the benefits of vitamins and nutrients is not supported by the available scientific data.”

From: The Wall Street Journal

Reviewed / Posted by: Scott W. Yates, MD, MBA, MS, FACP

Study: Patients often aren't told bad test results

No news isn't necessarily good news for patients waiting for the results of medical tests.


The first study of its kind finds doctors failed to inform patients of abnormal cancer screenings and other test results 1 out of 14 times.  The failure rate was higher at some doctors' offices, as high as 26% at one office. Few medical practices had explicit methods for how to tell patients, leaving each doctor to come up with a system. In some offices, patients were told if  they didn't hear anything, they could assume their test results were normal.


"It really does happen all too often," said lead author Dr. Lawrence Casalino of Weill Cornell Medical College. The findings are published in Monday's Archives of Internal Medicine.
"If you've had a test, whether it be blood test or some kind of X-ray or ultrasound, don't assume because you haven't heard from your physician that the result is normal," Casalino said.


Practices with electronic medical records systems did worse or no better than those with paper systems in the study of more than 5,000 patients.  "If you have bad processes in place, electronic medical records are not going to solve your problems," said study co-author Dr. Daniel Dunham of Northwestern University's Feinberg School of Medicine.  Dr. Harvey Murff, a patient safety researcher at Vanderbilt University Medical Center who wasn't involved in the study, said the researchers gave doctors "the benefit of the doubt" and still found a significant problem.


The researchers chose tests findings in which any doctor would agree patients should be informed. And they gave doctors a chance to explain when they found nothing in medical charts showing patients had been notified of bad test results.  The tests included cholesterol blood work, mammograms, Pap smears and screening tests for colon cancer.  Failing to inform patients can lead to malpractice lawsuits and increased medical costs, the researchers said.  "If bad things happen to patients that could have been prevented, that will lead to higher costs and in some cases considerably higher costs," Casalino said.


Researchers reviewed the medical records of more than 5,000 randomly selected patients, ages 50 to 69, in 23 primary care practices in the Midwest and on the West coast. They excluded dying patients and others with severe medical conditions where informing a patient would be redundant.


They surveyed doctors about how their offices manage test results. The offices that followed certain processes - including asking patients to call if they don't hear any news - were less likely to have high failure rates.  The study was funded by the California HealthCare Foundation.  "Our goal is not to indict physicians," Dunham said. "It's about working smarter and getting processes in place."


From USA Today
Reviewed / Posted by: Scott W. Yates, MD, MBA, MS, FACP

New Year's Resolution: Don't Just Sit

"Even if you're on the right track, you'll get run over if you just sit there." 
-- Will Rogers



"If everything is under control, you're going too slow."  
-- Mario Andretti

Inner Beauty: A Healthy Colon

Does your colon really need cleansing?  Few issues divide the worlds of conventional and alternative medicine quite so starkly.

According to a profusion of Web sites, clinics and wellness spas, the typical American diet of  processed foods, pharmaceuticals, stress and lack of exercise is clogging up our lower intestinal tracts, leaving them inflamed and lined with waste-and leaking toxins into the body that cause problems ranging from headaches and chronic fatigue to arthritis and cellulite. All that "stubborn fecal matter" also contributes to bulging bellies and expanding waistlines, cleansing proponents claim. Eliminating the buildup, either with supplements or laxatives, or by flushing the colon with warm water-a practice known as "hydrotherapy" or "colonics"-can dramatically improve a person's health and well-being, proponents claim. "Colonics help people get rid of what's in there, so they have a sense of 'Wow! That's what I should feel like,' " says Kim Dupre, who is owner of Wellville Healing Arts Center in Durham, N.C., and certified by an international organization of colon hydrotherapists.

Gastroenterologists pooh-pooh many of those claims. Healthy colons are self-cleaning, they say, and evacuating the colon via other means can do serious harm, even causing the sluggishness the cleansing purports to fix. "I've seen a lot of colons and the notion that people have pounds of feces and evil toxins built up in there is pure fantasy," says John I. Allen, a Minnesota gastroenterologist who has performed more than 20,000 colonoscopies, including many in patients who haven't drunk the traditional medical cleansing preparation  beforehand. Claims for colonics and other forms of cleansing, Dr. Allen says, "just play to people's fears and desire to lose weight."

The notion of emptying the intestines to cure illness was common in many ancient cultures, too. Egyptians performed enemas in rivers using hollow reeds. Colonic irrigation was been a staple of European spas for centuries, and it was all the rage in 17th-century Paris to have several enemas a day.

In the U.S., colon cleansing was common until the early 19th century, when conventional physicians began to challenge the lack of scientific evidence and condemn some practitioners as quacks.

In recent decades, colon cleansing has ridden a wave of interest in alternative medicines. Hydrotherapy spas-from storefront clinics to luxury resorts-have sprung up, especially in the South and West. And the Internet has fueled a boom in sales of at-home cleansing products.  Generally combinations of fiber, herbs, vitamins and stimulants, they often make enticing claims ("Ever wonder how the stars lose weight so quickly?" "Flush out up to 30 pounds!"). Some Web sites feature photos of long strands of rubbery-looking goo that customers claim they have expelled. ("I have lost some of the most horrific things you could imagine, and I have proof!")

Some Web purveyors even suggest that cleansing can cut one's risk of colon cancer; there is no such evidence, medical experts say. Attorneys for Oprah Winfrey and Mehmet Oz, a cardiologist and author, filed a suit last month in federal court in Manhattan accusing 40 Internet marketers of implying that their colon cleansers and dietary supplements have received the celebrities' endorsements. The U.S. Food and Drug Administration has warned some makers of colon cleansers about unsubstantiated claims, and some consumers have complained about being lured in by "free" trial offers for products, only to find themselves
charged $80 or more per month for shipments that are difficult to cancel.

Even within the colon-cleansing community, there is a wide spectrum of practices and competing claims. Steven Horne, a past president of the American Herbalist Guild, says use of home-cleansing products can result in startling results. But the expelled goo shown in online photos is most likely the mucilaginous fiber in the purging products themselves, combined with black bile from the liver, he says. "People do pass this stuff, but it's a myth that it's coming off the lining of their colon." Still, Mr. Horne says modern diets can irritate the lining of the GI tract and allow toxins to invade the body and cause illness-what he and others call the "leaky gut syndrome"-and that cleansing can help eliminate many health problems. He advocates a combination of natural fiber, digestive enzymes and herbal supplements.

"Not everybody needs to do this," Mr. Horne says, "but people who have chronic sinus problems or weak immune systems or general aches and pains seem to benefit a lot." He concedes there are few scientific studies to support the practice but adds, "I'm comfortable with that, because I've seen it in clinical experience."

Dr. Allen, who is on the American Gastroenterological Association's board of governors, says there is some scientific basis for leaky gut syndrome, but the problem is rare and primarily affects the small intestine. "If you biopsy a normal colon, there is no inflammation," he says. And there are illnesses, like inflammatory bowel disease and liver failure, in which toxins do affect the whole body. But cleansing proponents, he says, "have taken literature on disease states and tried to extend it to normal people."

Practitioners of colonics say their procedure is natural, because it avoids the use of laxatives and exercises colon muscles. A therapist inserts a rubber tube into the rectum and infuses up to 20 gallons of warm water into the colon (a traditional enema uses far less water and  involves only the last few inches of the colon). When the water is drained out, it brings fecal matter with it. The procedure often includes an abdominal massage.

"We are like personal trainers for the colon-we help re-educate those muscles about how they should be moving," says Ms. Dupre, who adds that many of her clients are constipated and need to change their diets.  "Otherwise, colonics are just a band-aid." She usually recommends a series of three to five weekly sessions (at $85 each), and monthly after
that. Gastroenterologists say that about 15% of the population suffers from constipation at some point, and some conditions and medications increase it. The best remedies are to increase dietary fiber, ideally from whole grains, fruits and vegetables, and to consult a  physician before trying other measures.

Some gastroenterologists worry that colonics can wash out beneficial bacteria and create infections, abscesses and electrolyte imbalances; there have been cases of rectal perforations. That is one reason that some hydrotherapists are pushing states to have formal licensing procedures. As of now, only Florida licenses colon hydrotherapists.  Texas requires patients to have a doctor's prescription; Rhode Island prohibits the practice.

Brian Landzberg, a Manhattan gastroenterologist, says people's notion that they have pounds of backed-up stool in their colons is helping to feed distorted body images. He says he frequently sees patients who have abused laxatives in an effort to lose weight or flatten their stomachs. "Those are some of my toughest patients to treat," he says, because overuse of some bowel stimulants can damage the nerves and walls of the colon and prevent it from functioning properly.

Some patients, he says, are so convinced they are constipated that only transit marker studies-which follow the passage of small markers through the intestine via X-ray-can persuade them that their "transit time" is normal. "There is a degree of obsession that goes along with this," says Dr. Landzberg. "You can't just accept a patient's report that they are
constipated."

Even "natural" laxatives, such as the plants senna and cascara, can harm the bowel, Dr. Landzberg says, adding, "The public has grown increasingly wary of the side effects of pharmaceuticals. I would like to see people bring that same degree of healthy skepticism to 'natural' products."

Where practitioners of conventional and alternative medicine do agree is in recommending improvements in the average American diet, to avoid gastrointestinal problems and lower the risk of colon cancer. 

"We do see a lot of constipation in Western civilization," says Dr. Landzberg. "We don't drink enough fluids. We are too sedentary, we have weakened abdominal muscles, and we don't take enough fiber in our diets.  But the answer to that is not artificial colon cleansing.  A
well-balanced diet with a good portion of soluble fiber-with lower fat and a calcium  supplement-makes a happy colon."

From The Wall Street Journal, by Melinda Beck
Reviewed / Posted by: Scott W. Yates, MD, MBA, MS, FACP

H1N1 Vaccine Update

We have received our supply of H1N1 vaccine from the State of Texas.  We'll contact member patients over the next week or so to arrange vaccination.  In the interim, feel free to call if you've questions or concerns.

Quotes from Soldiers

"You've never been lost until you've been lost at Mach 3."
-- Paul F. Crickmore (SR71 test pilot)


"'Whoever said the pen is mightier than the sword, obviously never encountered automatic weapons."
-- General Douglas MacArthur


"You, you, and you ... Panic.     The rest of you, come with me."
-- US Marine Corps Gunnery Sgt

MacArthur Genius Award: Reducing Falls in the Elderly

For a 75-year-old with high blood pressure, the risk of death or serious
disability resulting from a fall is just as high as the risk of death or
serious disability caused by a stroke. But a generation ago, doctors
thought of falling as an inevitable risk, not something they could do
anything to prevent as part of caring for patients.

That's how Mary Tinetti, a geriatrician at Yale med school, laid things
out for us when we got her on the phone to chat about the MacArthur
genius grant she just won. (Here's a complete list of this year's
winners, including several health-care geniuses.)

In the decades since Tinetti did her first research on the subject, she
and her colleagues have gone on to show that there are clear factors
that increase the risk of falls - things like muscle weakness, balance
problems and taking multiple medications. What's more, they found, by
addressing these issues, doctors can reduce seniors' risk of falls by
about 30%.

Still, not all patients get screened for these risk factors. Doctors
don't get paid much for spending time diagnosing and treating these risk
factors. And they don't fit into the disease/specialist model of health
care, which tends to focus on things like heart attacks and strokes.
"What needs to be done is very simple," she told us. "Figuring out how
to do it is the complex piece."

As a MacArthur Fellow, Tinetti gets $500,000 with no strings attached.
She says she plans to use the money to look more broadly at how to look
beyond single diseases to try use broader measures of well-being to
guide treatment of the elderly.

"What became obvious to me as I was doing the work on falls is the big
problem with older people is they don't have a single disease, they have
multiple diseases," she said. "All of our decision-making is based on
what's best for a single disease, not what's best for an individual
patient. What I'm interested in is how we can figure out what's best for
patients with multiple diseases so we can maximize benefits and minimize
harms."

From: The Wall Street Journal, by Jacob Goldstein
Reviewed / Posted by: Scott W. Yates, MD, MBA, MS, FACP

Dallas Providence Homes

Dr. Yates,


I appreciate the opportunity to share with you our work at Dallas Providence Homes and appreciate your personal involvement with our women and children.


Our Mission is to break the cycle of domestic violence for women and their children through long term transformational care that seeks to restore faith, hope and health. We accomplish this through our unique "transformational housing ministry" whereby we make a two-year commitment to our women and children.


We are NOT a shelter, which typically allows women to stay for 30, 60 or 90 days; we are a transformational housing ministry: we are the BRIDGE from the shelter back into the community. It is  during the 24 months that we provide acontinuum of care, counseling, housing and life skill training that will enable our women to become self sufficient.


Recent statistics for our ministry:

-1 in 4 residents who enter our program will graduate

-64% of our residents overcame their addiction before leaving

-100% of residents increased self esteem

-70% of residents did not know Christ when they entered, yet over 50% of them became believers before leaving

-Average wage earnings increased 77% upon leaving our program

-We reach our residents at a cost of less than $40 per day


One of our most recent success stories was a lady and her 8 year old son who came to us after having stayed at theSamaritan Inn, McKinney for almost 4 months.  When she entered our program, she had an interest in the nursing profession, but no formal training, and her son was failing in school. After completing our program which provided stability as well as education for her and her son, she accepted a job at M.D. Anderson in Houston and her son has been selected to attend two gifted classes, one in math and one in science.


There are a lot of good causes, however, If you have some interest in learning more about our ministry or how you can get involved in helping change the life of a woman or a child, please visit our website at www.dallasprovidence.org email Lori Conley, Executive Director, at execdirector@dallasprovidencehomes.org. or me at mw.hagan@tx.rr.com

Thanks so much for your interest in our ministry as it is through community that we are able to truly impact the lives of our residents.

Sincerely,

Mark Hagan

Founder, Dallas Providence Homes, Inc.