Reported cases of measles in England and Wales from 1940–2007. The graph shows the bi-annual cycle of epidemics that followed the war. (Photo credit: Wikipedia)

Only one third of health care workers in Britain have been asked if they are immune to measles before taking jobs to care for the ill.

So a recent study has called for a change: “To achieve complete immunity, it is cost-effective to screen and then offer immunization.” So how many of these workers were not immune to the measles? Oh, 3.3%. (Abstract at bottom of page)

That’s well above any standard for herd immunity, which varies between 80-90%. The concept of achieving complete immunity flies directly in the face of the reality that some individuals will simply not develop immunity despite multiple vaccinations. How many? Probably about 3.3%. The U.S. immunity has been estimated at 93%, and we have the compulsory vaccinations that Britain is considering.
The recent articles point to an epidemic of measles in Britain based on very low vaccination rates. Not for the children now, who are receiving vaccinations at U.S. rates, but for those in a certain time period when vaccination levels dropped in response to reports of links between measles vaccination and autism. British families do not see the sort of death rate from childhood diseases seen in low-income countries: “Children without a (vaccination) card at enrolment had a significant threefold higher mortality over the 2-year follow-up period than those fully vaccinated.”  If that was the case, then we wouldn’t be talking about vaccination at all. But the discussion has moved in higher income countries from saving lives to whether universal vaccination will achieve eradication and whether that goal supersedes parents’ choice.
Clearly the evidence does not support the idea that complete eradication of these illnesses is possible. If the U.S. levels are at 93%, then we have certainly achieved herd immunity status. But there are still measles outbreaks in the U.S. every year.

Whenever the outbreaks are among unvaccinated or primarily unvaccinated children, then the news covers the story extensively. But if the outbreak occurs among vaccinated children, the story does not get the same coverage. When an outbreak of measles occurs in a vaccinated population, the researchers will often redefine vaccination as receiving the maximum number of shots rather than just one.  Or they will point out that vaccination received outside the country is just not as good as a vaccine received locally.  The issue is not defined to measles. Whenever a vaccine is shown to be ineffective, the answer is not to question the vaccine, but to double the dosage. Witness the Maine change in vaccine requirements with the widespread outbreak of mumps nationwide in vaccinated college students.  Or the history of continued chicken pox in a highly vaccinated school.
While the most recent outbreak in Britain is getting press, there have been periodic outbreaks over time. Rather than getting our news from the newswire, it’s better to look at recent reports from Britain that have been fully analyzed by the experts. Here’s the report from Britain on a large outbreak from Jan-June of 2012: http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=20226

It notes that 92% of those eligible are getting vaccinated. So the parents are vaccinating now, we’re just going to keep claiming the current outbreak is because they weren’t vaccinating before, and all those children are affected.
In the last British epidemic, which  was last year at this time, how many cases were really the measles? Of 1,339 cases, 359 were confirmed as measles. Almost 40% were definitely not measles.

But those cases that were the measles were definitely all in the unvaccinated crowd, yes? It’s a bit more complicated than that: “Of the 359 confirmed cases, …84 (23%) were under one year of age and too young to be vaccinated and 106 (30%) were 15-years-old or older….Most confirmed cases eligible for vaccination, i.e. >12 months old, were not fully vaccinated (38% had no previous MMR vaccination, 16% had only one dose of MMR) and information was not available for 68 (19%) cases (Figure 2). Twelve of the confirmed cases had been vaccinated with two doses of MMR vaccine.”

So I’m a bit confused. The report says most of those older than 12 months were not full vaccinated, and then includes those that got one vaccine in with the 38% who were unvaccinated. If we reverse it, then most of those getting measles were at least partially vaccinated. Overall, we’re talking about initial reports of 1,339 cases, of which 359 definitely had the disease, and of those 68 were not eligible for vaccination. Those who definitely had not been vaccinated were 38%, or 111 people. So the epidemic of 1,339 people results more from doctors over-reporting (40%) than on actual cases (27%) and is blamed on 111 (8%) unvaccinated individuals.

Perhaps a better title for the news reports would be “Britain continues to get false reports of epidemics of the measles despite wide-spread vaccination.” But that wouldn’t sell papers.
The discussion of those who refuse vaccination is rife with judgments. A U.K. discussion of an outbreak in 2008 said “the primary case was probably an 8-year-old unvaccinated travelling child.” Evidently the “travelling community” is causing the spread of public disease. It’s best to lock your doors and move them along as quickly as possible. Vaccination needs to be treated as the complex issue it is for countries where it is no longer a life-or-death easy decision. It does not need to be used as a tool for class warfare or to terrorize a populace with tales of epidemics that are more over-reporting than substance.
Occup Med (Lond). 2003 Sep;53(6):398-402.

Prevalence of measles susceptibility among health care workers in a UK hospital. Does the UK need to introduce a measles policy for its health care workers?

Ziegler E, Roth C, Wreghitt T.

Source

Communicable Disease Surveillance Centre, 61 Colindale Avenue, London NW9 5EQ, UK. emma.ziegler@suht.swest.nhs.uk

Abstract

OBJECTIVES:

First, to determine the prevalence of measles non-immunity in a group of health care workers (HCW), and secondly, to investigate what pre-employment screening for measles is carried out by NHS occupational health departments.

METHODS:

Two hundred and eighteen HCWs with patient contact on the medical wards at Addenbrooke’s hospital provided an oral fluid sample and answered a questionnaire. A postal survey of Association of National Health Occupational Physicians Society (ANHOPS) members was conducted to assess whether UK NHS Trusts identify measles non-immune individuals.

RESULTS:

Of the HCWs tested, 3.3% of were found to be non-immune to measles (both oral fluid and confirmatory serum sample were measles IgG negative). Less than one third of a sample of 80 NHS occupational health departments enquired about measles immunity.

CONCLUSION:

The prevalence of measles non-immune health care workers is low, but with a fall in uptake of MMR immunization and increased likelihood of measles outbreaks, it is important to identify these at-risk individuals. Serum testing is the most reliable method to use. Oral fluid testing and history of measles disease or vaccination are unreliable methods of identifying non-immune individuals. To achieve complete immunity, it is cost-effective to screen and then offer immunization. NHS trusts vary greatly in their measles policies for health care workers.

PMID: 14514907
J Infect Dis. 2004 May 1;189 Suppl 1:S91-7.

Population immunity to measles in the United States, 1999.

Hutchins SS, Bellini WJ, Coronado V, Jiles R, Wooten K, Deladisma A.

Source

National Immunization Program, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA. ssh1@cdc.gov.

Abstract

To estimate population immunity, we examined measles immunity among residents of the United States in 1999 from serological and vaccine coverage surveys. For persons aged >or=20 years, serological data from the third National Health and Nutrition Examination Survey (1988-1994) were used. For persons or=12 years of age and 99% vaccine efficacy was used for those with failure of a first dose who were revaccinated. Overall, calculated population immunity was found to be 93%. Although there was not much variation in immunity by region and state, in some large urban centers immunity among preschool-aged children was as low as 86%. Overall, geographic- and age-specific estimates of a high population immunity support the epidemiological evidence that measles disease is no longer endemic in the United States.

PMID: 15106096
Epidemiol Infect. 2012 Nov 9:1-8. [Epub ahead of print]

Outbreak of measles in Central and Eastern Cheshire, UK, October 2008-February 2009.

Ghebrehewet S, Hayhurst G, Keenan A, Moore H.

Source

Cheshire and Mersey Health Protection Unit, Liverpool, UK.

Abstract

SUMMARY We describe the largest outbreak of measles in Central and Eastern Cheshire (North West England) since the MMR vaccine was introduced in 1988, the majority of cases were not vaccinated and more than 20% of the cases belonged to the travelling community. Over 4 months, 147 clinical cases of measles were notified locally to the Cheshire & Merseyside Health Protection Unit (CMHPU). Of these, 67 (45•6%) were laboratory confirmed, 42 (28•6%) were negative, and one was equivocal, leaving 23 probable and 14 possible cases. The primary case was probably an 8-year-old unvaccinated travelling child, symptomatic on 1 October 2008. Measles spread locally and within school-aged children until early February 2009. Most of Central and Eastern Cheshire, including 23 educational institutions (playgroups, nurseries, primary schools, secondary schools, colleges), were affected, showing that there were enough susceptible/unvaccinated children to sustain an outbreak. Nearly a quarter of the confirmed cases (15/67, 22•4%) were aged

PMID: 23137521

Related articles

• Autism vaccine scare leads to measles epidemic in UK (news.yahoo.com)
• UK Sees Surge In Measles Cases (blackchristiannews.com)
• Measles surges in UK years after vaccine scare (aurorasentinel.com)
• Measles surges in UK years after vaccine scare (seattletimes.com)
• U.K. scrambles measles vaccine to youth as outbreaks flourish (ctvnews.ca)
• Measles surges in UK years after vaccine scare (vitals.nbcnews.com)
• Measles surges in UK years after vaccine scare (cnsnews.com)
• Measles surges in UK years after flawed research (seattletimes.com)
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Risk-benefit profile of warfarin versus aspirin in patients with heart failure and sinus rhythm: a meta-analysis.

Generic regular strength enteric coated 325mg aspirin tablets, distributed by Target Corporation. The orange tablets are imprinted in black with “L429″. (Photo credit: Wikipedia)

The standard answer would be warfarin, but in an analysis of the studies it turns out that for patients with heart failure but normal heart rhythm, it makes no difference in overall outcome.

Warfarin patients had fewer strokes, including fewer bleeding strokes, but they tended to bleed more everywhere else. The overall effect on death rate was “neutral” meaning neither treatment was superior.

Since neither treatment was superior and warfarin patients bled more, the reviewers said aspirin was better overall.

Here’s the medline abstract:

Circ Heart Fail. 2013 Mar;6(2):287-92. doi: 10.1161/CIRCHEARTFAILURE.112.971697. Epub  2012 Dec 21.

Lee M, Saver JL, Hong KS, Wu HC, Ovbiagele B.

Source

Department of Neurology, Chang Gung University College of Medicine, Chang Gung Memorial Hospital, Chiayi, Taiwan.

Abstract

BACKGROUND:

The risk-benefit profile of warfarin versus aspirin for patients with heart failure in normal sinus rhythm has not been definitively established. Our objective was to evaluate the overall comparative effects of warfarin and aspirin in patients with heart failure and normal sinus rhythm.

METHODS AND RESULTS:

Pubmed, EMBASE, Cochrane Central Register of Controlled Trials, and Clinicaltrials.gov from January 1966 to June 2012 were searched to identify relevant studies. We included randomized controlled trials that included comparison of warfarin versus aspirin, and composite end point of death or stroke separately for active treatment and control groups. Summary incidence rates, relative risks (RRs), and 95% confidence intervals (CIs) were calculated using random-effects models. The search identified 4 randomized controlled trials of warfarin versus aspirin therapy, enrolling 3663 patients. There was no significant difference between the 2 treatments for the primary end point (warfarin versus aspirin: RR, 0.94; 95% CI, 0.84-1.06; P=0.31). Warfarin (versus aspirin) was associated with lower risk of any stroke (RR, 0.56; 95% CI, 0.38-0.82; P=0.003) and ischemic stroke (RR, 0.45; 95% CI, 0.24-0.86; P=0.02) but had a neutral effect on death (RR, 1.01; 95% CI, 0.89-1.14; P=0.89) and a higher risk of major bleeding (RR, 1.95; 95% CI, 1.37-2.76; P=0.0002).

CONCLUSIONS:

Compared with aspirin, warfarin does not provide benefit in the prevention of stroke and death among patients with heart failure in sinus rhythm, but raises the risk of major bleeding; and therefore its use in these patients is not justified.

PMID: 23264446

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• Bruise Control: Continued Warfarin Beats Heparin Bridging During Device Implantation (forbes.com)
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• Well: Ask Well: Coated vs. Uncoated Aspirin (well.blogs.nytimes.com)
• FDA Approval of New Drug to Treat Major Bleeding on Warfarin – Kcentra (professionalsblog.clotconnect.org)
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Breast implant: Mammographs: Normal breast (left) and cancerous breast (right). (Photo credit: Wikipedia)

Angelina Jolie 2003 (Photo credit: Wikipedia)

Well, that was a disturbing article in my local paper about Angelina Jolie choosing to remove her breasts.  Jolie was quoted that her breast cancer risk was an astronomically high number, which I found disturbing.  So I got to wondering:

How effective is preventative mastectomy?

One study says it’s eighty percent effective (based on what?), and that up to half of them suffer from negative body images after the surgery.

When compared to mastectomy, breast conserving therapy improved patients’ “body image, role, and sexual functioning.” More disturbingly, breast conserving therapy had better overall health outcomes. “Even patients > or =70 years of age reported higher body image and lifestyle scores.”

So why the trend toward mastectomy?

Even the supporters of prophylactic mastectomy admit that it has a “negative impact on body image, the intimate relationship and physical wellbeing.” (Breast Cancer Res Treat. 2002 May;73(2):97-112)
The saving grace is that you don’t get the cancer, right?

We’ve got studies showing that, don’t we? No.

It turns out that if you get a preventative mastectomy or a prophylactic mastectomy, we have no studies that show you don’t get breast cancer, or that you live longer. It seems reasonable to think that since you have less breast you have less breast cancer, but the same genetic mutations that increase the risk of breast cancer also increase the risk of ovarian cancer, so you may get that instead. Here’s the task force quote: “A primary care approach to screening for BRCA genetic susceptibility for breast and ovarian cancer has not been tested. No studies directly evaluated whether screening by risk assessment and BRCA mutation testing leads to a reduction in the incidence of breast and ovarian cancer and cause-specific and/or all cause mortality.” I put the abstract at the end.

Ok, so we know that outcomes from mastectomy are worse for women in terms of image, self-esteem, intimate relationships, and overall mood. We don’t know if removing the breasts conclusively prevents anything, because we don’t have any studies. It seems a bit premature to start recommending breast removal.  I wonder if Ms. Jolie was given the full picture of the situation before she went under the knife.

J Midwifery Womens Health. 2006 Nov-Dec;51(6):e45-9.

Body image after bilateral prophylactic mastectomy: an integrative literature review.

McGaughey A.

Source

Nurse-Midwifery educational program, University of Illinois at Chicago, IL, USA. amy.mcgaughey@gmail.com <amy.mcgaughey@gmail.com>

Abstract

Bilateral prophylactic mastectomy (BPM) can reduce a woman’s risk for breast cancer by 80%. Thus, women who are at high risk for familial breast cancer are increasingly opting for BPM as a preventative option. Research indicates that there are psychological benefits to BPM, including a reduction in anxiety about developing breast cancer. The purpose of this integrative review is to summarize the research that has examined the effect of prophylactic mastectomy on women’s subsequent body image. Thirteen studies were reviewed. The majority of women were satisfied with their decision. However, the majority of studies indicate that up to one-half of the women suffer a negative effect on body image and changes in sexuality. Knowledge of these findings can improve the practitioner’s ability to counsel women regarding this radical decision. Further research, particularly prospective studies, are needed to examine women’s body image prior to BPM so that the impact of prophylactic mastectomy can be examined more thoroughly.

PMID: 17081926

Breast J. 2004 May-Jun;10(3):223-31.

Quality of life following breast-conserving therapy or mastectomy: results of a 5-year prospective study.

Engel J, Kerr J, Schlesinger-Raab A, Sauer H, Hölzel D.

Source

Munich Field Study, Munich Cancer Registry, Ludwig-Maximilians-University, Munich, Germany. engel@ibe.med.uni-muenchen.de

Abstract

There are many conflicting results in the literature comparing quality of life following breast-conserving therapy (BCT) and mastectomy. This study compared long-term quality of life between breast cancer patients treated by BCT or mastectomy in three age groups. Patients (n = 990) completed a quality of life survey, including the European Organization for Research and Treatment of Cancer Quality of Life Core Questionnaire (EORTC QLQ-C30), at regular intervals over 5 years. In the cross-sectional data, mastectomy patients had significantly (p < 0.01) lower body image, role, and sexual functioning scores and their lives were more disrupted than BCT patients. Emotional and social functioning and financial and future health worries were significantly (p < 0.01) worse for younger patients. There were no differences in body image and lifestyle scores between age groups. There was also no interaction between age and surgery method. Even patients > or =70 years of age reported higher body image and lifestyle scores when treated with BCT. The repeated measures analysis indicated that four functioning scores, half the symptom scores, future health, and global quality of life improved significantly (p < 0.01) over time. All these variables increased significantly for BCT patients and those 50 to 69 years of age. Body image, sexual functioning, and lifestyle disruption scores did not improve over time. BCT should be encouraged in all age groups. Coping with appearance change should be addressed in patient interventions.

PMID: 15125749
Genetic Risk Assessment and BRCA Mutation Testing for Breast and Ovarian Cancer Susceptibility [Internet].

Editors

Nelson HD, Huffman LH, Fu R, Harris EL, Walker M, Bougatsos C.

Source

Rockville (MD): Agency for Healthcare Research and Quality (US); 2005 Sep.
U.S. Preventive Services Task Force Evidence Syntheses, formerly Systematic Evidence Reviews.

Excerpt

CONTEXT:

Breast cancer is the second most common cancer in women in the U.S. and is the second leading cause of cancer death. Although less common, ovarian cancer is associated with high morbidity and mortality. Both breast and ovarian cancer are associated with a family history of these conditions and, in some families, the pattern of cancers suggests the presence of a dominantly inherited cancer susceptibility gene. Two genes, BRCA1 and BRCA2, have been identified as breast cancer susceptibility genes, and clinically significant mutations are estimated to occur in about 1 in 300 to 500 of the general population.

OBJECTIVE:

Screening for inherited breast and ovarian cancer susceptibility is a two-step process that includes an assessment of risk for clinically significant BRCA mutations followed by genetic testing of high-risk individuals. The evidence synthesis describes the strengths and limits of evidence about the effectiveness of selecting, testing, and managing patients in the course of screening in the primary care setting. Its objective is to determine the balance of benefits and adverse effects of screening based on available evidence. The target population includes adult women without preexisting breast or ovarian cancer presenting for routine care in the U.S.

DATA SOURCES:

Relevant studies were identified from multiple searches of MEDLINE® (1966 to October 1, 2004), Cochrane Library databases, reference lists of pertinent studies, reviews, editorials, and websites, and by consulting experts.

STUDY SELECTION:

Investigators reviewed all abstracts identified by the searches and determined eligibility by applying inclusion and exclusion criteria specific to key questions about risk assessment, mutation testing, prevention interventions, and potential adverse effects including ethical, legal, and social implications (ELSI). Eligible studies had English-language abstracts, were applicable to U.S. clinical practice, and provided primary data relevant to key questions.

DATA EXTRACTION:

All eligible studies were reviewed and data were extracted from each study, entered into evidence tables, and summarized by descriptive and statistical methods as appropriate. Two reviewers independently rated the quality of studies using USPSTF criteria.

DATA SYNTHESIS:

A primary care approach to screening for BRCA genetic susceptibility for breast and ovarian cancer has not been tested. No studies directly evaluated whether screening by risk assessment and BRCA mutation testing leads to a reduction in the incidence of breast and ovarian cancer and cause-specific and/or all cause mortality. Assessment tools that estimate the risk of clinically significant BRCA mutations are available to clinicians, but have not been widely evaluated in primary care settings. Several referral guidelines have been developed for primary care, but there is no consensus or gold standard for use. Trials reported that genetic counseling may increase accuracy of risk perception, and decrease breast cancer worry and anxiety. Estimates of breast and ovarian cancer occurrence, based on studies of BRCA mutation prevalence and penetrance, can be stratified by family history risk groups that are applicable to screening. However, studies are heterogeneous and estimates based on them may not be reliable. Studies of potential adverse effects of risk assessment, genetic counseling, and testing reported decreased rather than increased distress. A meta-analysis of chemoprevention trials in women with unknown mutation status indicated statistically significant effects of selective estrogen receptor modulators in preventing breast cancer and estrogen receptor positive breast cancer, and significantly increased risks for thromboembolic events and endometrial cancer. Observational studies of prophylactic mastectomy and oophorectomy indicated reduced risks of breast and ovarian cancer in BRCA mutation carriers. Studies of patient satisfaction with surgery had mixed results; cancer distress improved, but self-esteem, body image, and other outcomes were adversely affected in some women. Applying this evidence to an outcomes table indicated that the numbers needed to screen to prevent one case of breast (4,000–13,000) or ovarian cancer (7,000) are high among women with an average risk of having a clinically significant BRCA mutation, and decrease as risk increases. Adverse effects also increase as more women are subjected to prevention therapies.

CONCLUSIONS:

The evidence base for genetic risk assessment and BRCA mutation testing for breast and ovarian cancer susceptibility as a screening strategy is limited by lack of studies demonstrating effectiveness, biases inherent in studies conducted in highly selected populations, and incomplete information on adverse effects.

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• How common is the BRCA gene mutation that Angelina Jolie has? (o.canada.com)
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Brain Teasers (Photo credit: harikrishnanbhaskaran)

The last thing anyone needs is to have memory loss as a side effect from a medication. But this is a very common side effect for a number of drugs.

Mild cognitive impairment is not dementia or Alzheimers, but it can significantly impact a person’s life and lead to a great deal of anxiety.  The culprits include any drugs that might block the rest-and-digest pathways of acetylcholine.  We all know fight-or-flight, the opposite is rest-and-digest, the deep relaxing feeling so many of us have so little these days.

Aging Brain Care will give you a free list of the biggest offenders in exchange for your email.  I got the list, and we’ve got a number of top sellers that wouldn’t necessarily show up on your radar screen for side effects.  Benadryl, Paxil, Seroquel or Dimetapp don’t immediately come to mind as possible memory blockers.

As the ABC folks make clear, it is important to look at the overall load of these drugs in a person’s system.  One or two may not be an issue, but if mom is taking three or more and can’t find her car keys, it may be time to visit her doctor and get some changes.

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English: Drawing of the face of a Parkinson’s disease patient showing characteristic symptoms: mainly hypomimia, a expression-less mask-like face. Appeared in Nouvelle iconographie de la Salpétrière 1 : clinique des maladies du système nerveux / publiée sous la direction du professeur Charcot,… ; par Paul Richer,… Gilles de la Tourette,… Albert Londe,…. – 1888. Chapter “Habitude exterieure et facies dans la paralyse agitante”. Plate XL1V (Photo credit: Wikipedia)

Here’s a rare early preventative measure for diagnosing Parkinson’s. In a study of restless sleep, researchers found that older patients who are suddenly “acting out” their dreams are at a much greater risk of developing Parkinson’s later on.  The acting out is called REM sleep behavior disorder, and shows a high correlation with Lewy bodies in the brain.  The symptoms of restless sleep showed up an average of six years before any other symptoms of Parkinson’s.

The correlations are there, but what is missing is whether early intervention might head off eventual disease and whether treating restless sleep aggressively might delay the onset of other symptoms.

You can find the abstract here.  The correlation was very high.  Of 175 patients, the majority had issues.  But most of the patients were men, so the study may not apply to women.

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Food for Life distributes food on an international basis produced solely from vegan and lacto-vegetarian ingredients. (Photo credit: Wikipedia)

The shorthand is that antioxidants are good, you should eat them as food, and that there is nothing particularly more “super” about a goji berry than a blueberry.  They are both super.  I just know somewhere in China someone is promoting “super Maine blueberry extract” rather than those nasty old Himalayan berries the locals can pick in their backyards.

But the Washington Post has gone into a bit of detail talking about common myths.  Here are the myths: Antioxidants are all vitamins, All antioxidants are created equal, eat pomegranates, berries and other “super fruits, amp up your intake with supplements, and more are better.

The last one isn’t a myth if you follow the rule to eat your antioxidants rather than popping and swallowing them.

Here’s my take home:  we need to eat more plants.  All the time, every day.  If you do that, you don’t need to take supplements.  If you don’t and swallow a handful of supplements with your burger, then guess what?  It doesn’t make you healthy.

Darn, I wish there was a shortcut to life, but there just isn’t.

Meat (Photo credit: yum9me)

If you are a paleo person, you may want to skip this post. Just as they came out with a pro-paleo for pregnancy study (infertile women do better on paleo, but it may be the hormonal intake as much as the protein), the World Health Organization has stomped on paleo toes by coming out against meat -again.

Here are the things, according to the consensus report you can do to add life. Average increase in lifespan was 1.2 years per point. (The Huffington Post has the complete article, I’m just summarizing here).

1) Be as Lean as Possible Within the Normal Range of Body Weight. (Before you quit because this is impossible, keep reading.)

2) Be Physically Active as Part of Everyday Life

3) Limit the Consumption of Energy-Dense Foods and Avoid Sugary Drinks.

4) Eat Mostly Foods of Plant Origin (Were they channeling the China Diet or the Omnivore’s Dilemma?)

5) Limit the Intake of Red Meat and Avoid Processed Meat

6) Limit Alcoholic Drinks

7) Limit Consumption of Salt and Avoid Moldy Cereal Grains and Pulses

8) Aim to Meet Nutritional Needs Through Diet Alone (There goes the entire supplement industry).

Ok, that’s their summary.  I’d shorten it to:  eat plants and stay thin and active.  Don’t be a drunk or eat mold.

It doesn’t sound that hard, so why do most of us fail to follow these guidelines?

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Choice is always yours (Photo credit: Bindaas Madhavi)

One of the common criticisms of Naturopathic medicine is that it doesn’t have studies of the same caliber as conventional medicine. Conventional doctors outnumber Naturopathic doctors on a scale of a hundred to one, and the vast majority of research is funded by or for drug companies. So the comparison has been a bit unfair.

But when we do get a good study like the one published in this month’s Canadian Medical Association Journal (abstact here), it does show positive results. Over a year, randomized patients experienced a 3% drop in cardiovascular risk and a 17% drop in metabolic syndrome.

To anyone familiar with Naturopathic Medicine, with its strong focus on lifestyle change over drug interventions, the results should come as no surprise.  Yes, dealing with diet and lifestyle is an effective way to treat cardiovascular disease and metabolic syndrome.  It seems a bit foolish that we need to do a study to show that the bread-and-butter of Naturopathic Medicine (or spouted-gluten-free bread and almond butter, if you prefer) is as effective as those same interventions by any medical group.  But as a tiny profession, Naturopathic Doctors have to show that they are an effective part of the healthcare puzzle.

Anyone interested in finding a local ND can start with  Naturopathic.org  the state-by-state listing of licensed N.D.s.  Those overseas and in unlicensed states should familiarized themselves with local licensing laws, as the level of education and training can vary widely.

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English: Extract from the text of the original document: “figure shows the fraction of gross domestic product (GDP) devoted to health care in a number of developed countries in 2006. According to the Organization for Economic Cooperation and Development (OECD), the United States spent 15.3 percent of its GDP on health care in 2006. The next highest country was Switzerland, with 11.3 percent. In most other high-income countries, the share was less than 10 percent.” (Photo credit: Wikipedia)

I want my doctor to be always right. When a doctor gives you the latin name for what ails you, it just feels good. The trouble is, doctors are humans. And humans make mistakes.

How many mistakes? Between 15% and 28% of the time. That’s almost one-in-three patients in a worst case scenario. It costs the U.S. Healthcare system seven hundred billion dollars, about a third of health care costs. (Data from Best Doctors’ report: here)

So how often do doctors think they misdiagnose?  In a survey of cancer doctors, the majority thought they misdiagnosed 0-10% of the time.  Less than 5% guessed they misdiagnosed 20-30% of the time, and about 2% estimated they misdiagnosed 30-40% of the time.  The Journal of Oncology estimates cancer misdiagnosis rates from 28% to 44%.

If the doctors who are making the diagnoses aren’t aware of the level of error they are likely to have, then they have no incentive to correct the error.  In the instance of cancer, a missed diagnosis means death, while a false diagnosis means hundreds of thousands of dollars of unnecessary, life-threatening treatment.

When asked about how to correct the problem, the cancer doctors asked for greater confidentiality about reporting errors, better technology, and changes in the laws.  None of them mentioned simply acknowledging that they were likely to make errors as a way to avoid making them.

 

Related articles

• Diagnostic errors more common, costly and harmful than treatment mistakes (esciencenews.com)
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• Bungling NHS doctors slammed after misdiagnosing boy’s cancer as growing pains (swns.com)
• Grandfather dies after doctors ‘misdiagnosed pea on lung for cancer’ (telegraph.co.uk)
• Former Sunrise Commissioner Fighting Colon Cancer (miami.cbslocal.com)
• Misdiagnosis is more common than you think (kevinmd.com)
• Report Finds Diagnostic Errors More Common Than Treatment Mistakes (medindia.net)
• To be hospitalized (ffueled.wordpress.com)
• There’s no easy cure for bad diagnoses (futurity.org)

English: Scrophularia nodosa, Scrophulariaceae, Woodland Figwort, Common Figwort, inflorescence. Deutsch: Scrophularia nodosa, Scrophulariaceae, Knotige Braunwurz, Infloreszenz. (Photo credit: Wikipedia)

A patient brought me the first two seasons of House for my viewing pleasure. I just watched “Damned If You Do” in which a nun is put into cardiac arrest after taking figwort tea and getting a tiny bit of epinephrine (adrenaline) injected.
Having never even heard of figwort tea causing this side effect, I researched it. While figwort does contain cardiac glycosides, there are no reports of figwort causing any side effects. Of the only forty-five studies on figwort in medline, only the rabbit intestine study would be relevant and it does not show the sort of smooth muscle contraction that would lead to a heart attack if a little epinephrine was added.
So what are we to make of Dr. House’s diagnosis of this nun based on the ingestion of figwort? Here we have medical fiction. There is no medical information that supports the interaction between figwort and the amount of epinephrine given. If he had talked about belladonna, or one of the more potent cardiac glycoside containing herbs, he might have had a diagnosis. But evidently the writers don’t know their herbs and picked innocuous figwort to play the villain.

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