Education As Preventative Medicine

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I always enjoy “meeting” someone on the internet who seems to hold the same views that I do and just recently, I came across an interesting article, Lifelong Learning and Wellness One Component to the Enlightened Gerosphere, in which the author, Paul David Nussbaum, Ph.D., Director, Neurobehavioral Services at St. John Center in Mars, Pennsylvania, put forth the suggestion that just as exercise and healthy eating are preventative, education can be a means of avoiding the dreaded Alzheimer’s.  As he writes:

Imagine an America where health insurance companies paid for attendance at church or synagogue, enrollment in higher education, residence within technologically advanced homes (smart homes) which can relay health information directly to the primary care physician, and even sustained employment. This approach to wellness stands in sharp contrast to the current model that incentivizes annual, invasive procedures such as a pap smear. While these ideas may render a humorous response, we must remember that the total dollar allocation for health care in this country is approximately one trillion dollars, and that one third (33%), or 300 billion dollars, of that total cost is for services delivered to the older adult. Despite this, Medicare and Medicaid are financially unstable. Imagine running a business in which you invest 300 billion dollars and yet the business is bankrupt! Perhaps we are not approaching the care of older Americans in a proper manner!”

I totally agree with Dr. Nussbaum’s assessment that nursing homes are not an answer, as I have written in previous posts, but because he writes it so eloquently, I will share what he writes:

Older Americans do not need high technology medicine, should not be treated in acute care centers as they suffer chronic illness, should not be forced to choose a nursing home, and should not be forced to retire or withdraw from a personal role and purpose. Instead, older Americans should have access to geriatricians who are afforded the same status of primary care physician as are pediatricians, should have access to a chronic care system, should be afforded multiple long term care options which do not include institutionalization and consequent family/financial death. Further, older Americans should be incentivized (financially) to remain well by promoting the social/human factors of health listed above.

I have championed the need to end the existence of nursing homes in the United States as I believe they represent the neglect of a great country to care for a vulnerable and needy segment of our population. Nursing and other services can be delivered without the cement walls of an institution. Nursing homes were built post-World War II and represented a warehousing model of care. Think about where nursing homes are located and you can understand the resulting removal of individuals from the vitality of life. My beliefs have nothing to do with the quality care and hard work that occurs every day in most of our nursing homes. In contrast, the United States must awaken to the fact that nearly one third of Americans would rather die than enter a nursing home, and the market has demonstrated consistently that potential employees seek work elsewhere— human beings do not want to live or work in nursing homes!

Again, Dr. Nussbaum so nicely summarizes the reality of aging in our society today:

Today, the United States has an extremely primitive understanding of aging. Our country maintains a negative perception about getting older, one that reflects a genuine misunderstanding of the facts regarding aging. For example, our entire social and legislative policy is based on an invalid age-threshold of 65. Clearly, we need to increase this age-threshold to reflect more accurately the expected lifespan of Americans. Most people are not aware that age 65 was employed for social benefits by Chancellor Bismarck in Germany over 100 years ago.  Americans believe that advanced age leads to poverty, illness, Alzheimer’s disease, nursing home placement, depression, and loneliness. These entrenched perceptions exist despite facts that nearly 70% of older adults (those living beyond 65) are independent, financially stable, happy, healthy, and productive. Further, the vast majority of older Americans do not have Alzheimer’s and do not live in nursing homes.

So my blog is entitled “education as preventative medicine”  Where does this part of the article begin.  Right here!  Dr. Nussbaum states that

Fortunately, researchers interested in neurodegenerative disorders such as Alzheimer’s disease (AD) which affects four million Americans, and costs the country 100 billion dollars annually in direct care and 30 billion dollars in indirect care related to caregiver illness, have underscored the importance of education as a potential preventative factor against AD. Multiple studies have demonstrated a reduced risk of AD for those with advanced education. The neurobiological explanation of this has been labeled Reserve Theory. Essentially, information which is learned must be processed by our brains, itself a physiological event. Such learning promotes development of new neurons and neural pathways. The theory advances that with increased cell density and cell volume, a progressive disease such as AD will not impact the brain or will impact the brain at a later age because the disease will have to destroy a greater number of cells to manifest clinically. The increased volume of cells in the brain provide a reserve to fight off invading diseases such as AD. Interestingly, the Reserve Theory has been advanced for other etiologies of dementia besides AD.

Although there is more in Dr. Nussbaum’s article on studies demonstrating more proof, I would refer the reader’s to his article, as I have reached my word quota for this particular blog.  Thank you, Dr. Nussbaum.

Copyright Yvonne Behrens 2014

 

 

 

 

 

Death and Dying

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Apparently the topic of death and dying is starting to become less taboo in our society.  I have just come across two articles that speak on this subject.  Now I do  not want to insinuate that we have turned a chapter on this topic.  We certainly continue to be a society that would rather avoid anything that reminds us of death than recognize that it is part of life.  As Walter Mosley penned in The Last Days of Ptolemy Grey: ““We born dyin’…But you ask a man an’ he talk like he gonna live forevah.”

However, since those days in 2009, when ugly looking American Citizens held up signs like”Obama has created death panels” or “kill grandma” in response to a provision that had been placed in the Health Care Reform Act to enable doctors to receive compensation for end of life counseling [and because of all that nastiness, the provision was removed], we as a nation seem to have sobered up on the topic of death.

Recently, a new movement has occurred: death cafes.  According to Stacey Burling, Inquirer Staff Writer,

Death cafes are based on the ideas of Bernard Crettoz, a Swiss sociologist. They had made it to England by 2011 and were soon on their way to the United States, according to deathcafe.com, the mother organization of the “social franchise.” It says 200 death cafes have been held in nine countries.

I find it interesting that death is such a taboo subject.  It is almost as though people believe that they might bring it on if they talk about it.  But the fact is that we are all headed to the grave at some point or another in our lives and we should accept that fact.  As we do, we will become better prepared to deal with the topic.  As it is, we still wish to avoid it and so these baby steps that are starting to appear in our country are a very positive sign and not morbid in the least.  Further in Burling’s article, she quotes:

Raphael is a rabbinic pastor with Jewish Renewal, an emerging denomination. He’s also a therapist and death awareness counselor. He founded the DA’AT Institute for death awareness, advocacy, and training.

He thinks this is a great time to talk about death. Baby boomers are aging and many are losing their parents. Hospice participation is increasing. People are interested in near-death experiences and Eastern religions.

“I think we’re living through this profound revolution in terms of our cultural attitudes toward death,” he said.

He believes death is still more of a “great intimacy” than sex, and a topic that feels taboo to too many. That means many don’t get the support they need when someone they love dies. On the first day, friends will greet them with a serious, long face, he said. On day two, they’ll ask, “How you doing?” By the third day, friends have moved on and people are left to “live with their grief in this kind of invisible way.”

There are even “death dinner” events that also focus on the topic of death and dying.  Dinner, always being a place for good social gathering, seems a great way to bring up the taboo topic.  From a blog by mother nature network

The website Death Over Dinner offers a way to facilitate the process. It gently leads the organizer through a series of questions that can help make the planning of such a get-together a little more straightforward. Asking about who you’d want to attend, what your intention is (to make specific plans, to get a real conversation going about death and dying, or to prepare for another’s death), and even providing resources to watch, listen and read, the site helps you navigate what can be complex, emotional waters.

So yes, if not now, when?  Let’s talk death and dying!

copyright Yvonne Behrens 2014

 

 

 

 

Prescription Drugs Detected in Drinking Water

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We have recently heard about the contaminated waters in the Elk River in West Virginia due to leaking toxic materials.  But for years now, our water sources have been the recipient of other potentially harmful elements: prescription drugs.

I have written in the past that pharmaceutical drugs are a predominant fixture in our society.  They are so prevalent, however,  that they have started to seep into our environment.  According to several sources,

Traces of prescription drugs—including antibiotics, anti-convulsants, mood stabilizers and sex hormones—have been detected in drinking water.  (Wikipedia, USA Today, Sunday Telegraph)

The Environmental Protection Agency (EPA) did a study and found that the level of drugs found in our water supply is much higher than previously thought:

Specifically, more than half the samples of waste water from major cities tested by the EPA tested positive for at least 25 drugs. “We were surprised to find that many drugs occurring across all the waste water plants,” EPA research biologist Mitchell Kostich told The New Republic. “We were also surprised to see so many drugs of a particular class – the high blood pressure medications — appear at those levels across the board.” – See more at: http://healthydebates.com/25-plus-drugs-half-americas-drinking-water/#sthash.pWqKQ5Pl.dpuf
How, you may ask, do these drugs get into our water system?  Think about it:  the drugs are in our system, they are in our waste as well.  We are told to flush unused drugs down the toilet.  Right there are two sources.
In a survey conducted by CBS:
Researchers [found] that nearly 70 percent of Americans are on at least one prescription drug, and more than half receive at least two prescriptions, reports CBS Atlanta.
This adds up to a lot of pharmaceuticals being dumped into our water systems.

If these chemicals are being found in our drinking water, they have to be entering other parts of the eco-system as well, ie, the fish we eat.

These findings frighten me.  We speak about the war on drugs and yet one could make a case that the biggest culprits are those who “push” pharmaceutical drugs on the unaware general public.  The irony is that the “pusher” is probably not fully cognizant of his/her role in the whole sordid picture or, at least,  I certainly hope not. Every time a doctor writes a prescription, he/she is potentially creating an addict. Think about it. How often have you heard a doctor stop something he/she has prescribed for a “chronic” situation such as high blood pressure (one of the highest levels of drugs found in our water systems) or high cholesterol?

Both of these “chronic” situations can be alleviated by exercise, eating properly, and removing oneself from stressful situations. But in the world we inhabit today, we take pills. Our doctors prescribe them and he/she must know that it is important to take these pills for our health.  Also, let’s face it: pills are so much easier to pop than going to the gym or preparing a meal…. and, it takes so much less time….. and, God knows, time is a luxury these days.  To add insult to injury, in spite of knowing that these pills may have potentially nasty side effects, we continue to push them into our mouths and swallow.

Many of the drugs we take have been presented to us as something we will need to take for the rest of our lives.  As an example, blood pressure medication.  Doctors caution, in no uncertain terms that once one starts taking blood pressure medication, they need to remain on it for the rest of their lives.  However, this may not be true.

Take the story of my mother-in-law. She had been on blood pressure medication since her 50′s. Her blood pressure probably had spiked as she entered menopause. The doctor had told her that she had to take the blood pressure pills for the rest of her life. When she had moved in with us, she had been taking this prescription drug for high blood pressure for over thirty-five years. Everyone assumed that these drugs were working beautifully because her blood pressure was normal.

One day, as fate would have it, she came down with pneumonia. She eventually recovered because of the miracle drug: antibiotics.

About ten days after my mother-in-law returned home, her doctor noted that somehow her blood pressure pills had not been resumed. Lo and behold, her blood pressure was still normal. He told us not to resume them. Who knows when she could have actually quit? But worse, think about how many people are on high blood pressure pills in our country today and how many might not need to be? A financial boom for the pharmaceutical companies, certainly.  Yet also, according to the EPA study, one of the most prevalent drugs found in our water systems.

© Yvonne Behrens, M.Ed  2014

 

 

 

Do Economics Influence Attitudes Towards Aging?

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I have been working on a power point presentation entitled “One Size Does Not Fit All.”  The presentation will focus on how the cultural  mores of the aging population in our country are beginning to influence how we, as a culture, need to respond.

While doing research on this project, I am finding some very interesting studies.  One in particular struck a chord:  How economics influences our attitude towards aging.

Early studies which focused on socioeconomic predictors found that higher levels of economic development and industrialization are associated with less favorable attitudes towards aging and a lower societal status of older adults (e.g., Simmons, 1945Arnhoff, et al., 1964Maxwell, 1970Bengtson, Dowd, Smith, & Inkeles, 1975Palmore & Manton, 1974).

Why would this be?  Well, first off, the more money there is, the easier it is to “put an elderly away.”   In this country, retirement communities have sprung up all over and have, in fact, become an accepted part of the aging process.  This, in turn, means that grandchildren do not have a lot of opportunities to spend with their grandparents.  If the grandparent is not a regular part of the child’s environment, what sort of rapport can develop between the two individuals?  The less youth has an opportunity to interact with older citizens, the more likely they will develop a disdain for the apparent fogginess they encounter and even the inability to close the cultural gap that naturally exists between the energy of youth and the less energetic elder.

On the other hand, if a child grows up with [a] grandparent(s) in which the grandparent(s) [is] a very dynamic part of their world, their attitude will be very different.  There will be a bond.  There will be a sense of love.  They will actually see that Grandma or Grandpa has many sides to their personality.  They might even have the opportunity to see how grandma or grandpa change as they age and recognize that this is the natural order of things.

In turn, if the grandparent(s) [is] in a retirement community and the family visits them once a week, usually on a Sunday after church or brunch and the kid is in a strange environment, still in his/her church clothes witnessing a forced situation of having to make conversation, how much relating can really occur?  Most children don’t think to ask their grandparent what their life was like when they were younger.  So they sit there, feeling awkward in front of a virtually old stranger, just waiting for the moment when they can get up to leave to go home.

(Cowgill, 19721986) argues that industrialization has undermined the societal status of older adults and with the break up of the traditional extended family through urbanization, has shifted the value of the elder’s means of production and experienced based knowledge to a much lower rung.  Although in some circles, modernization theory is considered an oversimplification, I find that there is enough within the studies that validate the argument that modernization has had a negative influence in society’s general attitude towards its aging population.

In a study done by Corinna E. Löckenhoff, National Institute on Aging, Baltimore, USA, the researchers approached their study with the following predictions:

In general, we predicted that perceptions about aspects of aging that are strongly linked to biological changes (i.e., physical aging and changes in fluid cognitive abilities) would show less variation across cultures and fewer associations with culture-level variables than perceptions of socioemotional aspects of aging (e.g., family relations and life satisfaction) and societal views of the aging process. For culture-level associations with socioeconomic characteristics, we expected to replicate previous research indicating that advanced development is associated with less favorable perceptions of aging.

Their findings confirmed this.  Utilizing Dutch Sociologist, Geert Hofstede’s value dimensions:

participants from cultures with greater Uncertainty Avoidance* reported more negative societal views of aging. Uncertainty Avoidance was also associated with less favorable expectations about age-related changes in family authority and life satisfaction. Further, participants from cultures higher in Power Distance** reported less favorable views of age-related changes in knowledge and wisdom.

Although this is a large topic of which only a small piece is reviewed in this blog entry, it just is another indication of how we need to re-think aging and bring it back as part of the mix.

 

* the concept of Uncertainty Avoidance deals with a society’s tolerance of ambiguity and uncertainty.  The more structured a society is, ie, Germany, the less comfortable its citizenry is with ambiguity.

** Power Distance refers to how those individuals who are less powerful within an entity (whether a society or a family) accept and expect inequality in the power structure with which they find themselves.

 

 

 

 

 

 

Obamacare is Coming! Obamacare is Coming!

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[Ed. note: Although I try and avoid political entries on this blog, the topic of this blog has been so politicized, that I am not able to avoid it.]

In spite of the fact that representatives in Congress have tried to repeal the Health Care Reform Act a whopping 40 times, open enrollment is due to begin on October 1 and the Health Care Reform Act, aka Obama Care, officially will go into effect the first of January 2014.  That is the good news.

The news that really chagrins me is that each time the obstructionists in Congress tried to repeal the law (which would actually benefit most American citizens) they did so to the tune of 1.5 MILLION dollars.  EACH time!  SIXTY MILLION DOLLARS of OUR tax dollars ended up being spent for what I can only conclude is shenanigans on the part of the obstructionists.  These are the same people who keep telling us that the government does not have enough money to operate.  They are the same people who can get the very best healthcare available at a 72-75% discount.*  As we have been the only developed nation in the world that still does not provide universal healthcare to its citizens, the actions of these obstructionists has been destructive.  Okay.  Politics over.  Back to the good news.

Starting October 1, people will be able to choose their healthcare coverage and healthcare provider.  Health insurers are no longer allowed to deny individuals with pre-existing conditions.  They are no longer allowed to drop individuals if they cost them too much or put a lifetime limit on benefits.

The following is the coverage that every citizen will have a right to regardless of the healthcare plan they choose.

Free annual check ups; Emergency services; Hospitalizations; Laboratory services; Maternity care; Mental health and substance abuse treatment; Outpatient, or ambulatory care; Pediatric care; Prescription drugs; Preventive care; Rehabilitative services; Vision and dental care for children.

Open enrollment will allow one to compare coverage options before enrolling.  In this new requirement that all citizens own health insurance, the government is offering an exchange rate between what the premiums cost and what the insured will have to pay. This exchange rate will be determined by the individual states.

In Virginia for example:

The average premium, without tax credits, would be $237 a month for the lowest-cost bronze plan and $335 a month for the second-lowest silver plan.

For a family of four making $50,000, a mid-range plan, after tax credits, would be $282 a month under the second-lowest silver plan. Without a tax credit, $799.

For a 27-year-old person earning $25,000 a year, the premium would be $80 a month, with a tax credit, for the bronze plan and $145 for the silver plan, also with a tax credit.

Six out of 10 Virginians who are uninsured will be able to find coverage for less than $100 a month when tax credits and Medicaid coverage are included.

 

© Yvonne Behrens, M.Ed  2013

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*According to the Congressional Research Service, the FEHBP offers about 300 different private health care plans, including five government-wide, fee-for-service plans and many regional health maintenance organization (HMO) plans, plus high-deductible, tax-advantaged plans. All plans cover hospital, surgical and physician services, and mental health services, prescription drugs and “catastrophic” coverage against very large medical expenses. There are no waiting periods for coverage when new employees are hired, and there are no exclusions for preexisting conditions. The FEHBP negotiates contracts annually with all insurance companies who wish to participate. There is plenty of competition for the business; FEHBP is the largest employer-sponsored health plan in the U.S.

Like other large employers, the government pays a large share of the cost of coverage. On average, the government pays 72 percent of the premiums for its workers, up to a maximum of 75 percent depending on the policy chosen. For example, the popular Blue Cross and Blue Shield standard fee-for-service family plan carries a total premium of $1,327.80 per month, of which the beneficiary pays $430.04. Washington, D.C.-based employees who prefer an HMO option might choose the Kaiser standard family plan. It carries a total premium of $825.15 per month, of which the employee pays only $206.29.  (Factcheck.org)

 

Drug Addiction — The Pharmaceutical Kind

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Recently I read an article in america.aljazeera. com entitled, “Painkiller Addiction Worst Drug Epidemic in U.S. History.”  According to the article:

In the United States, enough painkillers were prescribed in 2010 to medicate every American adult around the clock for one month.

That is a LOT of pills.  No wonder the pharmaceutical industry is one of the most lucrative money-making industries in the world!  You may recall that I wrote about an experience in my family which may not be so atypical given this article.

We have all heard about the extreme addictive qualities of  Vicodin and Oxycontin.    I had a friend who was battling cancer and her doctor had her on Oxycontin for five years.  He originally had prescribed it to her because she was feeling pain in her bones, but it was not long into her use that it was clear that she was hooked.  She made no apology and felt no remorse, choosing, understandably, a high that might decrease some of both the physical and emotional distress that her cancer was causing her.   Her story might be a justifiable one for the use of Oxycontin.  However, there are many stories of doctors who provide Oxycontin to their very wealthy patients on the most superficial of claims.

Oxycontin is the drug of choice among the wealthy and many articles have been written on the widespread misuse of this drug. In part this is because the Food and Drug Administration (FDA) has painted broad strokes for what constitutes enough pain to justify the use of Oxycontin.  In spite of the fact that there has been urging on the part of a group called “Physicians for Responsible Opioid Prescribing,” the FDA has done nothing to change their denotation of what constitutes justifiable pain.  This topic is rather slippery since the claim can be made that individuals do have different pain tolerance.  However, with the high levels of abuse that have been documented in the widespread use of Oxycontin, one might wonder whose pocket the FDA may be in.

After his resignation from his post as Commissioner of the FDA in December 1969, Herbert L. Ley, Jr., in an interview with the New York Times, warned the public about the FDA’s inability to safeguard consumers. People were being misled, he believed: “The thing that bugs me is that the people think the FDA is protecting them – it isn’t. What the FDA is doing and what the public thinks it’s doing are as different as night and day,” he said. …… Ley was critical of Congress, the Administration and the drug industry; he stated that he had “constant, tremendous, sometimes unmerciful pressure” from the drug industry and that the drug company lobbyists, combined with the politicians who worked on behalf of their patrons, could bring “tremendous pressure” to bear on him and his staff, to try preventing FDA restrictions on their drugs. The interview concluded with Ley stating that the entire issue was about money, “pure and simple”.[47][48]

This was back in 1969.  If anything has changed since then, it is that the pharmaceutical companies have even more leverage with the FDA.

In a 2005 interview, Dr. David J. Graham, associate director of the FDA’s Office of Drug Safety, was asked “What Specifically do you believe is broken in the FDA and what needs to be done to fix it? What must be done to improve the drug vetting system ?” his response: ” FDA is inherently biased in favor of the pharmaceutical industry. It views industry as its client, whose interests it must represent and advance. It views its primary mission as approving as many drugs it can, regardless of whether the drugs are safe or needed.”

Back to the Aljazeera article I read on the American addiction to pain killers:

Prescriptions for painkillers in the United States have nearly tripled in the past two decades and fatal overdoses reached epidemic levels, exceeding those from heroin and cocaine combined, according to the Centers for Disease Control and Prevention (CDC).

At the same time, the first-ever global analysis of illicit drug abuse, published this month in the British medical journal The Lancet, found that addictions to heroin and popular painkillers, including Vicodin and OxyContin, kill the most people and cause the greatest health burden, compared with illicit drugs such as marijuana and cocaine.

High-income nations, such as the United States, the United Kingdom and Australia, had the highest rates of abuse, 20 times greater than in the least affected countries, according to the Lancet study.

It would seem that our love affair with pharmaceutical drugs is not doing a whole lot to help us in our health but it sure as heck is helping the pharmaceutical industries to make lots of money.

© Yvonne Behrens, M.Ed  2013

 

 

Heart Surgeon Comes Clean

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As you may recall, I wrote on two documentaries “Forks Over Knives” and “Chow Down”, both documenting how it is what we eat that affects our health.  Since then, I seem to be coming across more and more articles in which doctors are claiming that health begins with what we eat, not the pills we pop or the surgical procedures we undergo.  This is refreshing and heartening.

Recently, I read a wonderful confession by a Dr. Dwight Lundell, a heart surgeon for over 25 years.  He claims:

I trained for many years with other prominent physicians labelled “opinion makers.” Bombarded with scientific literature, continually attending education seminars, we opinion makers insisted heart disease resulted from the simple fact of elevated blood cholesterol.

The only accepted therapy was prescribing medications to lower cholesterol and a diet that severely restricted fat intake. The latter of course we insisted would lower cholesterol and heart disease. Deviations from these recommendations were considered heresy and could quite possibly result in malpractice.

It Is Not Working!

These recommendations are no longer scientifically or morally defensible. The discovery a few years ago that inflammation in the artery wall is the real cause of heart disease is slowly leading to a paradigm shift in how heart disease and other chronic ailments will be treated.

Dr. Lundell then continues:

The long-established dietary recommendations have created epidemics of obesity and diabetes, the consequences of which dwarf any historical plague in terms of mortality, human suffering and dire economic consequences.

Despite the fact that 25% of the population takes expensive statin medications and despite the fact we have reduced the fat content of our diets, more Americans will die this year of heart disease than ever before.

Statistics from the American Heart Association show that 75 million Americans currently suffer from heart disease, 20 million have diabetes and 57 million have pre-diabetes.

Dr. Lundell then explains chronic inflammation:

…..without inflammation being present in the body, there is no way that cholesterol would accumulate in the wall of the blood vessel and cause heart disease and strokes. Without inflammation, cholesterol would move freely throughout the body as nature intended. It is inflammation that causes cholesterol to become trapped.

Inflammation is not complicated — it is quite simply your body’s natural defence to a foreign invader such as a bacteria, toxin or virus. The cycle of inflammation is perfect in how it protects your body from these bacterial and viral invaders. However, if we chronically expose the body to injury by toxins or foods the human body was never designed to process,a condition occurs called chronic inflammation.

And it is chronic inflammation that causes ill health like heart disease and diabetes.  So what is the cause of chronic inflammation?  Surprise, surprise, according to Dr. Lundell, it is:

… the overload of simple, highly processed carbohydrates (sugar, flour and all the products made from them) and the excess consumption of omega-6 vegetable oils like soybean, corn and sunflower that are found in many processed foods.

Our wise doctor continues:

There is but one answer to quieting inflammation, and that is returning to foods closer to their natural state. To build muscle, eat more protein. Choose carbohydrates that are very complex such as colorful fruits and vegetables. Cut down on or eliminate inflammation- causing omega-6 fats like corn and soybean oil and the processed foods that are made from them.

One tablespoon of corn oil contains 7,280 mg of omega-6; soybean contains 6,940 mg. Instead, use olive oil or butter from grass-fed beef.

Dr. Lundell’s recommendation?

Animal fats contain less than 20% omega-6 and are much less likely to cause inflammation than the supposedly healthy oils labelled polyunsaturated. Forget the “science” that has been drummed into your head for decades. The science that saturated fat alone causes heart disease is non-existent. The science that saturated fat raises blood cholesterol is also very weak. Since we now know that cholesterol is not the cause of heart disease, the concern about saturated fat is even more absurd today.

Three cheers for Dr. Lundell and his honesty.  Thank you, Dr. Lundell.

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A Story About Our Medical System

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I have to get my decks power washed and stained.  The man who is doing the job, very nice, friendly, talkative, shared the fact that last year, he had a major heart attack.  I asked if I could share his story and this is it:

“I am 42 years old.  Now I don’t like doctors and I don’t like hospitals.  So something has to feel really wrong for me to even consider either.  I was working on a job, it was around Christmas last year, three days before Christmas to be exact.  I started to feel pretty terrible.  I had been having some chest pains on and off, but, you know, you don’t really think that it might be a heart attack.  Heck, I’m only 42 years old, so….But that day, I was really feeling a lot of pain.  I decided to go home.  I called my wife and told her that she needed to call an ambulance.  When I got home, the ambulance had not arrived yet.  She gave me aspirin.  It was winter.  It was cold.  They came and I told them that I thought I was having a heart attack.  They looked at me and replied, “Nah. Can’t be.  You are too young.  You are still standing up.  We’ll take your blood count.”  Apparently the blood counts were off the charts, causing the orderlies to jump into high gear.

They told “Jack” to get into the ambulance.  They had called ahead for a helicopter to come to the local hospital because his counts were so high.  They had called the destination hospital, alerting that this patient needed immediate attention.  By this time, “Jack” was shaking with cold.  The orderlies told him they would keep him warm in the ambulance.   “I kept grabbing at more and more blankets.  I just could not warm up.”

Off he went in the helicopter.  Yet when he arrived at the destination hospital, he ended up waiting up to two and a half hours before he went into surgery.  His wife, who drove home from the local hospital to get supplies (they had a baby), arrived forty five minutes after her husband did and helped finish the check in.   He had still not been seen by a doctor.

It turned out that one of the arteries was blocked 95%.  They put a stint in.  The next day, he was ravenous and ready to leave the hospital.  They only provided a menu for a heart patient, which, as one can imagine, was pretty light fare.  ”I told them that I needed to eat something and if they were not going to feed me, I would get up and leave and go get some real food.”  The doctor relented and he was able to eat a hearty (no pun intended) breakfast.

“I really wanted to spend Christmas at home with my family.  The doctors told me, ‘absolutely not!  You need to heal from the surgery.’  I replied that the way I was going to heal was to be with my family.  Thankfully, they did release me on Christmas day.”

He was given a slew of medications to take, including blood thinners and Statins.  He was supposed to go back for a re-check three months after the surgery.  ”I missed that appointment, but finally got back last week.  They found that my heart had recovered 99% of its abilities.  They were totally amazed since they said  this was very unusual.  But they also told me that my cholesterol was still too high and so they put me on a stronger Statin, Lipitor.”

Apparently, they are suggesting that he only do this for a year.  They will re-test in December to see whether he needs to continue.

Jack continued: “The doctor gave me a coupon for one of the  medications.  This medication costs $280 a bottle and the doctor told me, what with the fact that I work for myself, that if this was too cost-prohibitive, he would write me a prescription for a different medication.  Turned out that bottle cost $18.  I chose the medication that cost $18.”

“Now I’m not saying I am hundred percent and I don’t feel like I used to.  I have made some adjustments and I have slowed down, but I wonder where I would be had I not taken some initiative.”

One could say that “Jack” is a miracle story.  One could even conclude that had he not been tended at the hospital, he might not have been telling me his story.  On the other hand, where would “Jack” be if he had stayed in the hospital, under doctor’s advisement, eating “heart-healthy” meals for X amount of days?  What about the fact that there are two drugs out there that apparently have the same effects: one for $280 and the other for $18, and why did the doctor not suggest the latter in the first place?  And as for Lipitor, “don’t get me started!” [a bow to Billy Chrystal]  The side effects of this drug should be enough to prevent anyone from even considering ingesting this bit of poison.  But most people who are given it, take it, no questions asked.  Why?  The label says: potential side effects.

In conclusion…Some of the story shows our medical system at its best and some of the story shows areas that our medical system needs an overhaul.

An Article About a Drug Recall

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Recently, I came across the following article (see below).  Since it contains any and all the elements I might point out had I written the article or even just quoted parts of this article, I am inserting the whole article, with an occasional comment of my own.

David Maris, author of the following article which first appeared in Forbes Magazine:

Pay attention, as I can’t say this seriously enough. Last week, the FDA took a drug off the market, and the reasons should send shivers of fear down the backs of consumers, investors, generic drug companies – and the FDA.

The FDA announced last week that the 300mg generic version of Wellbutrin XL manufactured by Impax Laboratories and marketed by Teva Pharmaceuticals was being recalled because it did not work. And this wasn’t just a problem with one batch – this is a problem that has been going on with this particular drug for four or five years, and the FDA did everything it could to ignore it.

The FDA apparently approved this drug – and others like it – without testing it. The FDA just assumed if one dosage strength the drug companies submitted for approval works, then the other higher dosages work fine also [my emphasis]. With this generic, American consumers became the FDA’s guinea pigs to see if the FDA’s assumption was right. It wasn’t.

Background

In December 2006, the first generic versions of the popular anti-depressant Wellbutrin XL were approved by the FDA.  The drug comes in two dosage strengths, 150 milligrams and 300mg. The 300mg dose is generally used for patients with more severe depression and anxiety and patients who don’t respond to the lower dose.  The FDA approved generic versions of both dosage strengths from a few generic drug companies: Teva Pharmaceuticals (manufactured by Impax Laboratories and marketed by Teva Pharmaceuticals), Anchen, Actavis, Watson Pharmaceuticals and Mylan MYL -0.95% Pharmaceuticals.  Almost immediately, the FDA started receiving reports from patients that claimed the 300mg dose was being associated with side effects and reduced efficacy.

The People’s Pharmacy, a well-known syndicated radio and newspaper columnist husband and wife team, notified the FDA that hundreds of patients had logged their own complaints of side effects with the then-recently approved generic version of Wellbutrin XL. The FDA brushed off the People’s Pharmacy and others that raised the issue, stating that they had faith that the drugs were equivalent and that perhaps the patients, who had mental disease, were more prone to perceived problems with a change in the medication than others. This was seen by many as essentially telling patients “it’s all in their head.” [my emphasis added].   After several more years and public outcry, the FDA was forced to take action.

What Action Did The FDA Take?

Instead of doing its own study on the drug, the FDA asked the drug maker to conduct a study to determine whether the generic drug was equivalent to the brand. [my emphasis added and I will also add that asking the makers of a drug to conduct their own study might smack a little of conflict of interest. This also brings up a point that was made in the movie "Chow Down" that the FDA is not as independent a regulatory body as we are led to believe and their relationship with the food and drug industries are a lot closer than their relationship with the American people.] The FDA, in their recent press release, claims that Teva started the trial but later abandoned it because of slow patient enrollment. It was already 2010, several years after knowing there was a problem, the FDA was forced to do its own study.

Did The FDA Drag Its Heels?

The FDA study was completed in August 2012 – more than 5 years after the initial problems were reported. The FDA study showed that the 300mg dose from Teva is ineffective insomuch as it did not deliver enough of the drug.

Oddly, despite the result being available in August 2012, the public was only made aware of this in October 2012.

How Did This Happen?

When the FDA issued its press release on October 3rd, it said that the FDA made a mistake in that it had taken the data for the 150mg version.  Since that dosage had worked fine, the FDA just assumed that the 300mg dosage would work.  I am not joking – they indicated that this case caused them to change the way they do things.  They approved the drugs by extrapolating the data for the 150mg, assuming the 300mg works the same.

Clearly, the FDA has serious doubts on how they approved the 300mg dosages by just assuming if the 150mg works then the 300mg must work also. The FDA’s press release makes that clear:

FDA has approved five generic versions of Wellbutrin XL 300 mg. Each of these generics was approved based on bioequivalence studies comparing the 150 mg strength of the products to Wellbutrin XL 150 mg. Studies were not performed directly on the 300 mg strength of the products. Rather, the bioequivalence studies were performed using the 150 mg strength, and the results were extrapolated to establish bioequivalence of the 300 mg product.

FDA has determined that this approach is no longer appropriate to establish bioequivalence of 300 mg bupropion hydrochloride extended-release tablets to Wellbutrin XL 300 mg, and the Agency is revising its guidance to industry for how to conduct premarket bioequivalence studies in generic bupropion products.

This cleverly worded press release hides the fact that this method of approving Wellbutrin XL or any drug is not only “no longer” appropriate, but was never an appropriate way of approving drugs.  Just extrapolating data is an erroneous assumption and ignores basic principles known by most high school science students. In addition, if you don’t test the larger dosages, what if drug companies simply submitted 300mg drugs that had no drug in them?  That seems like more than just a moronic mistake, but a dangerous approach to approving drugs.

But What About The Other Generics The FDA Approved?

Instead of immediately pulling the drugs that were approved with the same faulty approach and instead of the FDA doing their own bioequivalence studies, the FDA has asked the other generic drug companies to do these tests for the FDA and submit these results by March 2013.  The idea of a regulatory agency turning over the testing process of a drug to the drug companies when there is doubt about their safety and efficacy seems like it is giving up its role of independent oversight of the companies it has regulatory power over. [my emphasis]

It seems more appropriate that the FDA conduct these tests and, since the safe brand drug remains on the market, to immediately remove the other generics while we await the results of the testing. [I totally agree with the author's conclusion]

The FDA has long been a strong proponent of generic drugs, and generics have saved consumers and the federal government billions of dollars vs. brand-name drugs.  Many consumers incorrectly believe that a brand drug is identical to the generic drug, and even the FDA on its website calls generics “identical.”  Generic drug companies are subject to FDA inspections just like their name brand counterparts, but the drugs themselves do not need to be identical to the brands; they need to be “bioequivalent” and are given leeway on how close to the brand they need to be.   To me, it’s similar to how Cheerios are almost like the store brand of toasted oat cereal – “Cheery-O’s” – very similar, but not the same.  Roughly speaking, “bioequivalent” means they need to show that the drug releases an active ingredient in nearly the same, but not exact, concentration as the brand.

The whole system works if the generics are bioequivalent, and to ensure that they are, most consumers believe that the FDA would test to see if the generics being considered for approval work as promised.  It appears that many approved generic drug versions have not even been subject to independent FDA studies. [my emphasis]

But how could the FDA know if a drug is bioequivalent if it doesn’t even test it?  It can’t.

How This is A Safety Issue

The lack of efficacy for a high dose anti-depressant is really a safety issue, not a manufacturing issue.

How many patients who were not adequately treated on the 150mg dose were put on the 300mg only to see their symptoms get worse because the generic did not work as promised?  How many patients, doctors, and their families thought that this was simply a further deterioration of a patient’s condition and mental state? How many parents had to worry about their children when their anti-depressant seemed to stop working?  How many people committed suicide taking a generic antidepressant that did not work?

And the appalling part of all this is that the fact that this could have been prevented if the FDA had simply tested the drug before they approved it, or at the least heeded the hundreds of complaints.

8 Immediate Steps That Should Be Taken

Here are eight steps that should be taken immediately to address this crisis and the underlying issues that caused it:

  1. The FDA should immediately suspend approvals for generics Wellbutrin XL and advise doctors via a Dear Doctor Letter to switch to the brand. Pending confirmatory studies, suspend approvals of the other generics.  It is clear if the FDA is asking manufacturers to do new studies on these drugs, it does not 100% trust its effectiveness and safety.  The FDA should not keep drugs on the market where it cannot stand by the efficacy and safety of the drug when the brand is readily available
  2. The FDA should conduct their own study of the bioequivalence of the other generic Wellbutrin XL it approved and not rely on the drug makers.
  3. The FDA should immediately conduct a review of all generic drug approvals in this class and others to determine what other approvals were made with the same faulty approach of assuming that if one dose worked then the higher dose or lower dose must work the same.  Since the FDA has now abandoned this faulty procedure because it resulted in ineffective drugs being put on the market, then it should re-review all these previous approvals.
  4. The FDA should conduct a thorough study of how the vigilance system of early warnings and warnings from others such as the People’s Pharmacy went unheeded for more than 5 years.
  5. The FDA should undertake the difficult but important step of researching which patients took the 300mg generic, which ones may have attempted or committed suicide while on the 300mg or shortly after being switch from the ineffective. Research how many institutionalized patients are on the 300mg dose – advise they are switched to the brand immediately.  The families of these patients should know why the drugs they trusted to work didn’t.
  6. The FDA should tighten the regulations for bioequivalence for narrow therapeutic window drugs, especially those that pharmacists and patients have already complained about not working.
  7. The FDA should provide consumers with the timeline and all correspondence and phone records surrounding this case to show why a two month delay would take place from knowing the drug did not work to telling the public.
  8. Congress should convene an oversight committee on how this happened and what it means for drug safety. Was there anyone at the FDA during this or previously that had issue with the “if the 150mg works, then assume the 300mg works too” approach?

The FDA Commissioner Peggy Hamburg needs to answer for this.  When you keep score by loved ones’ worry and by patient lives cut short by suicide, this is not just the tale of a simple recall, but of a failure of the system and sign of dangerous incompetence.

 

Note: An earlier version of this posting identified the recalled product as being from Teva Pharmaceuticals.  For greater clarification, we have noted that the generic drug subject to the FDA action is manufactured by Impax Laboratories and marketed by Teva Pharmaceuticals

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No part of this article is intended to be investment advice nor should it be considered investment advice.  For disclosure purposes, at the time of this writing, I own shares of Teva Pharmaceuticals.

 

Nothing more need be added to this nicely presented article.

 

Should the Topic of Bi-polar Disorder Be Made Into A Lighthearted Movie?

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The other day, (well now it has been a couple of months!  I am so not keeping up with this blog!)  some friends and I went to see the movie “Silver-Lining Playbook.”  It was a good movie.  The acting was excellent.  I assume that if Bradley Cooper had not been up against Abraham Lincoln, he would have won an Oscar for his portrayal of an individual with bi-polar disorder.

However, the story line itself was total fantasy and, as the movie proceeded,  it became more and more a fantasy.  Maybe the author of the book/movie entitled the story, “Silver-Lining Playbook” precisely to let the movie viewer know that we would be shown a fantasy. But any of us who have seen/lived with someone diagnosed with bi-polar disorder knows that this dis-ease (at least up until now) does not have a silver lining attached to it.  I found the fantasy that the movie portrayed a bit over the top.  Now I know that American movie goers tend to love the happy ending story and this was as fairy tale-ish  “…and they lived happily ever after” as it gets.  But I found it a little disturbing to approach the topic of an illness wherein there has been no cure found [as of yet] in such a fantasy like way.

Bipolar disorder has no single cause. It appears that certain people are genetically predisposed to bipolar disorder. Yet not everyone with an inherited vulnerability develops the illness, indicating that genes are not the only cause. Some brain imaging studies show physical changes in the brains of people with bipolar disorder. Other research points to neurotransmitter imbalances, abnormal thyroid function, circadian rhythm disturbances, and high levels of the stress hormone cortisol.  These imbalances purportedly can be modified with pharmaceuticals.  But pharmaceuticals have their side-effects, some of which can be pretty nasty.

External environmental and psychological factors can be involved in the development of bipolar disorder. These external factors are called triggers. Triggers can set off new episodes of mania or depression or make existing symptoms worse. However, many bipolar disorder episodes occur without an obvious trigger.

  • Stress – Stressful life events can trigger bipolar disorder in someone with a genetic vulnerability. These events tend to involve drastic or sudden changes–either good or bad–such as getting married, going away to college, losing a loved one, getting fired, or moving.
  • Substance Abuse – While substance abuse doesn’t cause bipolar disorder, it can bring on an episode and worsen the course of the disease. Drugs such as cocaine, ecstasy, and amphetamines can trigger mania, while alcohol and tranquilizers can trigger depression.
  • Medication – Certain medications, most notably antidepressant drugs, can trigger mania. Other drugs that can cause mania include over-the-counter cold medicine, appetite suppressants, caffeine, corticosteroids, and thyroid medication.
  • Seasonal Changes – Episodes of mania and depression often follow a seasonal pattern. Manic episodes are more common during the summer, and depressive episodes more common during the fall, winter, and spring.
  • Sleep Deprivation – Loss of sleep—even as little as skipping a few hours of rest—can trigger an episode of mania.

Lithium is the oldest and most commonly used mood stabilizer. It is “highly effective” for treating mania. Lithium can also help bipolar depression. However, it is not as effective for mixed episodes or rapid cycling forms of bipolar disorder. Lithium takes from one to two weeks to reach its full effect.  But some of the side effects of lithium include:

weight gain, drowsiness, tremors, weakness and fatigue, memory and concentration problems, stomach pain, thyroid problems, nausea, vertigo.

Of course every doctor will tell you that not everyone develops these side effects, but if you happen to be one of the ones who does, would you willingly subject yourself to them?

In extreme cases, antipsychotics may be prescribed for bipolar disorder.

Antipsychotic medications used for bipolar disorder include:

  • Olanzapine (Zyprexa)
  • Quetiapine (Seroquel)
  • Risperidone (Risperdal)
  • Ariprazole (Abilify)
  • Ziprasidone (Geodon)
  • Clozapine (Clozaril)

The common side effects of antipsychotic drugs are similar to those of the mood stabilizers: Drowsiness, Weight gain, Sexual dysfunction; Dry mouth; Constipation; Blurred vision.

Often, antipsychotic medications are combined with a mood stabilizer such as lithium or valproic acid.  So you can imagine what someone on both antipsychotic drugs and mood stabilizers might look like.  This is why I put the words “highly effective” in quotes.  By whose definition?

My apologies to the readers: I seem to have lost the sources by which I got my details on symptoms and remedies.  However, a google search for bipolar disorder will bring up pages with which you can further educate yourself.  But please, please, do not think that the two individuals portrayed in “Silver-Lining Playbook” are representative.

© Yvonne Behrens, M.Ed  2013