Friday, May 30, 2008
Lead poisoning can result in permanent neurological damage resulting in learning and behavioral problems. This was highlighted recently by articles showing children in poor areas had high levels of lead and this resulted in criminal behaviour. The sad thing it is preventable. Lead poisoning today is not just limited to poor areas with lead in wall paint.
There are numerous source of lead: in our soil, air, drinking water, and homes. There is over 3 million tons of lead in 60 million American homes. It is found on watercoolers at school, windowsills, in the dirt in yards, seals of fine wine, lead crystal glasses, dishes, coffee mugs, crayons, on toys, and even in calcium supplements.
Homes built before 1976 contain some lead in their tap water because of solid lead pipes or lead soldered copper pipes.
Children absorb 50% while parents only 10%. Children pick up lead dust from floors, pets, and toys and then suck their thumbs. The lead compound on paints taste sweet. Lead is stored in baby's teeth and their kneecaps. Lead finds to the red blood cell like iron and is stored like calcium in the teeth. When there is a deficiency of protein, phosphorus, iron, or calcium, more lead is absorbed.
Hobbies like soldering and melting lead is a great source of lead poisoning. Burning colored newsprint or wood coated with lead paint, results in a release of lead into the air. Lead gasoline, phased out in 1976, was also a great source. Storage, preparation and serving of foods are another source. Juices from containers that come from lead soldered cans can leak the acids into the juice and be absorbed.
Pigmented designs on pottery dishes and mugs are glazed with lead to make them washable. The glaze contains deadly cadmium. This lead can be absorbed when hot food is served on them. Leaking is increased by acidic food as coffee, pop, fruit juices, or alcohol, combined with the decorative glaze and lead pigment.
In 1990, 90 % of all canned food was packaged in lead soldered cans (98%lead and 2% tin; lead is 10% the cost of tin.). Note that soldered seams are raised and lumpy with gray metal while welded seams are soft, smooth and flat.
Wine formerly had corks sealed with hot wax and lead foil wrapped around it. The lead went into the wine. Place the wine in fine crystal and you also have immediate absorption of lead also from the crystal directly into the wine.
Calcium pills are made from bone meal and oyster shells (sources of lead). Best to choose calcium carbonate or antacids for your source of calcium. Brass bowls contain 3% lead. Pewter is made from tin and lead. Silver plates contain often an alloy of lead. Newspapers with colored print contain lead. (So don't wrap your fish in the comics.) Water coolers had lead lined storage tanks until 1988. Sandblasting of old bridges releases a large amount of lead.
Pregnant moms absorb more lead than non-pregnant woman. The average lead levels were 17 micrograms per cc in 1976 and today are 4 micrograms. In 1965 the levels were 60 and dropped down in 1985 to 30 and by 1990 to 10 micrograms.
We still must look out for the dangers of lead poisoning. It is entirely preventable and treatable.
Your comments are always welcomed. Please visit us @ www.drneedles.com.
Thursday, May 29, 2008
BICARBONATE USED TO DETECT EARLY CANCERS
Researchers in Cambridge England found by tagging sodium bicarbonate and injecting it into the body, one could detect early cancers using MRIs. The bicarbonate affects the acid and alkalinc balances in the body.
All cancers are more acidic than surrounding tissues. Cancer cells turn the bicarbonate to CO2 All cancers have a lower pH than its normal surrounding areas. The more acidic the tumor, the more bicarbonate is converted to CO2. The MRI can track the change in the chemical and thus locate very early cancers.
WHAT IS THE MEANING OF ALL THIS?
It is important to find new ways to detect cancers early and to see if the drugs are working.
Using this technique, one could find out if cancer treatments are effective in early stages . Currently we have no way to measure the pH differences in the patient.
This could be a highly sensitive early warning system for cancer. This technique may be a useful tool in finding early cancers and may save many lives.
SOURCE: Dr, Brindle, Cambridge Cancer Research Institute UK 5.28.08
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Wednesday, May 28, 2008
FERTILIZATION IN VITRO
Genetic screening before IVF significantly reduced the rate of pregnancies in women between 35-41 years of age.
There were 350,000 IVF cycles in 2002, with half of the women over 35 years of age. They tend to have more chromosomal abnormalities in their embryos.
Genetic screening before implantation involves aspirating a single blastomere from each embryo, and identifying the copy numbers of a set of chromosomes. It was to become the standard procedure before IVF.
Indeed, there is a higher implantation rate for transferred embryos, but no increase in the rated of successful pregnancies. Instead, it significantly reduced the live birth rates after IVF.
The pregnancy rate per aspirated follicles is 11.7% in the group having genetic screening before implantation and 14.7% in the control.
The number of chromosome analyzed with FISH leads to transfer labeled embryos normal that are in fact abnormal and anacuploid.
Many human embryos are mosaic so their chromosomal constitution may not represent the entire embryo.
SOURCE: NEJM 7.5.07
The primary outcome in fertility studies should be live births since that is the goal of the treatment. Biopsy of a blastomere on day 3 has the potential of an embryo to successfully implant and increases the chance of a live birth by 80%.
These results oppose routinely performing genetic screening before implantation as an aid to IVF.
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WATER PIPES SMOKING VS. CIGARETTE SMOKING
Recent studies in the Harm Reduction Journal showed the Hookah water pipe smokers have low levels of carinoembryonic antigens, CEA. They imply it might be a solution for heavy cigarette smokers.
Those who smoked the hookah, and no cigarettes, bits, etc. had an equivalent of 60 cigarettes each day. The authors found the overall cancer antigen levels were not different from the levels of non-smokers and moderate smokers. However, the heavy smokers of the pipe had significantly high levels of the cancer antigen.
They claim that low nitrosamine smokeless tobacco could be an alternative for heavy cigarette smokers and suggest even low quality moist snuff called naswar could be helpful.
Source: Harm Reduction Journal 5.24.08
Beware of the implication of such research. According to the World Health Organization, the water in the hookah does not filter out all the “ bad stuff”. The user is still exposed to 150% the volume of smoke inhaled from one cigarette.
Tobacco smoke still contains high levels of toxic compounds including carbon monoxide, heavy metals, and yes carcinogens. A significant amount of addictive nicotine is still inhaled. The tobacco is no less toxic and more smoke is inhaled because of the massive volume of smoke inhaled.
Naswar is a snuff from the Middle East that is chewed, nasty, and very addictive also. Your dental bills will also skyrocket.
Switching from one poison to another is not the answer. Stop the nicotine habit. Consider medical acupuncture to quit. For information on quitting with acupuncture, visit www.drneedles.com
Your comments always appreciated.
Over 200,000 retired federal employees are unnecessarily enrolled in 2 prescription drug plans that duplicate coverage. The retirees have a Federal Employee Health Benefit Plan that gives them better coverage than Medicare Part D.
The Government pays for both plans but the retirees choose the Federal Plan because it gives them more coverage. Since the Medicare Part D plan is never used, the private insurance companies that cover this plan keep all the $200 premiums paid by the government and keep every dollar. There is no government coordination between the two plans.
This is another way our tax dollars are at work in the medical field.
What do you think?
Source: House Oversight Government Reform Committee 5.12.08
Your comments are always appreciated.
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Sunday, May 18, 2008
Source: NEJM 9.13.07
Vigorous exercise during exposure to high levels of air pollution in heavy traffic may trigger an acute cardiovascular event. A study of 20 men who had a history of cardiac infarctions exercised in an area with high diesel pollution. They all showed a strong association between air pollution and heart ischemia and infarction.
Exposure suppressed net t-PA release and showed impairment of fibrolytic activity. All the men showed ST segment depression and a great ischemic burden during the diesel exposure.
Mechanism of indirect effects from agents crossing the lung epithelium into the circulation included soluble transient metals. The autonomic balance became disturbed resulting in a higher risk of arrhythmias and disruption of arterial plaques. The pulmonary oxidative stress lead to systemic inflammation causing the altered fibrolytic activity.
Decreased oxygen supply to the heart occurs because of vasoconstriction of the arteries and a transient thrombosis formation. There is also a decreased oxygen carrying capacity causing higher levels of carbon monoxide and increased oxygen demand.
The changes in t-PA release show a predisposition to thrombosis formation when a plaque is disrupted.
Patients with coronary disease, who did not have an infarction with transient exposure to air pollution or have sub clinical disease with perhaps plaques, can have a cardiac event triggered by vigorous exercise.
Exercise in traffic free areas is beneficial, but jogging in heavy traffic may be hazardous to your cardiac health. Perhaps health clubs are the answer.
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By law and medical ethics, doctors need informed consent to treat patients. The patient must be competent to make a voluntary choice.
A doctor determines if the patient is competent to make decisions, but the patient’s autonomy must always be respected. If the patient is incompetent, an informed consent is invalid.
In the hospital, a patient may make an impaired decision especially in neurological and infectious diseases. A study of over 300 inpatients showed 48% were incompetent to consent to medical treatment and ½ had mild to moderate dementia. Every patient may have some limitations in capacity with old age, little education, language problems, and cognitive impairment.
Currently unstructured judgments by doctors are standard. Yet their assessments greatly vary.
Legal standards for decision making for informed consent require:
1.Ability to communicate a choice
2. Understand the relevant information
3. Understand the medical consequences of a situation
4. Ability to reason about treatment choices.
How can a doctor protect you from the consequences of a bad choice and still respect you autonomy? Most people are capable of making their own decisions and very few are really incompetent.
As doctors see the seriousness of the consequences of the patient’s decision, they rate many patients incompetent. Older patients may not hear or see well and are on hospital medications that may make their mental comprehension temporarily fuzzy.
In an assessment one must be sure that:
1. The patient was given relevant information to make an informed decision about their treatment
2. Disclose the true nature of the patient’s condition and offer available alternative treatments
3. Be given the option of no treatment at all
If one is impaired, one should identify the source of the impairment and try to remedy the cause. Perhaps fever, dehydration, sedation, or lack of oxygen can make the patient temporarily impaired. Fear, anxiety, and lack of education can also interfere with making a competent judgment.
When an advanced directive is absent, and there is no immediate urgency, a family member must be contacted. Today there are no clear standards and guidelines to assess a patient’s capacity to consent to treatment. This is what makes lawyers happy and leads to increased confusion. Don’t let your rights be violated.
What do you think? Your comments always appreciated.
Source: NEJM 11.01.07
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The food and drug agency, better known as the FDA, is a 102 year old agency. The FDA has the authority to mandate adequate clinical trials post marketing of the safety of the drugs that were approved. They could require time tables for completion and reporting of these trial. An annual review of the drugs safety after one year of approval would be helpful.
MONEY IN ACTION
THE FDA receives 2 billion dollars annually in funding its activity. Congress increased that amount last September by $145 million dollars. Only 38 million of this is allocated for drug reviews. The FDA wants a 100% raise in its budget to do its job.
Half of all drug review money, $400 million dollars, comes from drug companies. The drug safety budget was increased slightly by Congress by increasing drug user fees to speed decisions on drug approvals. The FDA says user fees would never result in compromising the FDA’s independence. Congress would never permit it. But the perception problem still exists.
User fees by Big Pharma is really a conflict of interest for the FDA. I doubt it will disappear soon and probably will be increased to provide more money for safety assessment.
The public trust in the agency has dropped in the last 5 years from an approval rating of 67% to 36%. With the recent heparin story, vioxx scandal, approved antibiotics that destroy a liver in 5 days, and a diabetic drug that increases the risk of heart attacks, its public approval rating continues to drop.
WHAT DOES THE FDA REGULATE?
The agency regulates $1.5 trillion dollars in:
Food, drug, vaccines, dietary supplements and vitamins
Blood and tissues issues
Medical devices, radiation-emitting machines, cell phones
Animal feeds and drugs
Gene therapy and biotechnology
Monitors food born terrorist plots
Heart valves and pacemakers
THE FDA IS UNDER PRESSURE
Pressure is on to soft pedal its problems.
Drugs get to market without follow up
Speed up decisions on new drug applications
Review time has been cut from over 2 years to less than 1 yr.
Life saving drugs should be sped along, but with user fees up, all drugs are accelerated, creating new dangers.
With deadlines, not too many questions can be asked
What Big Pharma says about safety is accepted as fact
Drugs are approve that do not work and have safety problems Drug reactions have increased from 250,00 to 500,000 annually
With only one of three drug reactions reported Deaths have tripled from 5000 to 15,000
When a drug or medical device is approved, the FDA makes a judgment call about its safety. They rely on the manufacturers small clinical trial studies, following in a targeted small group of patients, 500 to 3000 patients, over a few months to measure the drugs safety and effectiveness. They do not consider the wide variety of health problems the drug might pose when used in a wide variety of conditions.
Only after a drug is used for months or years by thousands of patients can true risks show up. This kind of drug surveillance is the moat important phase of testing. Drug user money is not allowed to be used to check drug safety once it is released to market. Follow up reports by the drug company are not mandatory. Only 1/3 of the studies the drug companies promise to conduct are ever begun.
CONGRESS PUT INTO ACTION
Congress allowed the FDA this year to spend 25 million dollars of the user fees collected to check drug safety. It wants the FDA to require drug companies to trace their long term effects of their drugs by penalties up to $10 million for repeat offenses.
Results of clinical trials no longer can be trade secrets. Bad news will have to be released as well as good news. In January, the NEJM reported! /3 of all drug trials were never reported. This allowed doctors to think the drugs are more effective than they really are.
Companies now must post results of their clinical trials on a public database within one year after they are completed. Unfortunately the drug company’s clinical trials have 3 years to post summaries for the general public. This is the only way to know what medical research and treatments contribute of our society.
Companies must report any severe reactions that are life threatening within 15 days. A web site www.fda.gov/med watch is available for doctors to download a form to report problems. However, very few doctors use it and hence very few severe reactions get passed on.
There is very little time or money to record this information.
A half million pages of faxes come to the FDA now each year with 1/3 of these serous issues. There are 35 report analysts that have 8 minutes to read each case. Not enough money is available to really hire more staff to do a good job.
Congress recently mandated the FDA to connect to a large medical record database run by Medicare, HMOs and the Veterans Administration. Adverse drug reactions will be tracked and analyzed faster. New drugs with side effects will be relabeled or pulled off the market faster. The FDA will be able to mandate warning labels without bargaining with the drug companies.
Other things Congress could do but has resisted:
Having a substantial penalty for drug ads that overstate effectiveness and underestimate the dangers of their drugs. Having drug labels updated as soon as safety and efficacy information becomes available. Some surveliance system to monitor drug reactions and placement of these reactions on large public datablases. These databases could register the clinical trials of the drugs tested. It has also been recommended that there be some reporting by the patients themselves of adverse effects of drugs by having a toll free telephone number and web address on the drug labels and on drug ad sites.
FDA ADVISORY BOARDS
The FDA advisory board votes on drugs and new devices and represents a broad spectrum of research, patient advocates and doctors. Yet 50% of its members have financial interests in companies whose drugs the evaluated over their rival’s drugs. Since Big Pharma pays for most of the clinical research done a hospitals and universities, its hard to find experts that are not tied to the drug industry. Congress said it will not ban members with conflict of interest, but said over the next 5 years they must reduce by 25% committee members with such ties.
IT SEEMS INDUSTRY IS THE FDA, S CLIENT, NOT JOHN Q. PUBLIC.
The Union of Concerned Scientist took a poll of 1000 FDA scientists. Twenty percent said the 2006 decision makes them provide incomplete inaccurate and misleading information to the public, media, and elected government officials. Forty percent said they could not politically express their public health concerns without FDA retaliation. Congress last year created an office of Chief Scientists of the FDA to solve this problem. This would allow staff members a place to air their debates on the quality of research. It also gives them the right to publish their critiques in the medical journals and even publish their minority assessments even if overruled.
WHAT STAFFER WOULD ACTUALLY DO THIS?
Has all these new teeth made the FDA tougher on the drug industry? Enforcement has actually dropped 50% between 2000 and 2005. Regulation this year makes manufacturers of medical devices, as fibrillators and pace makers, immune from lawsuits by the patients.
Sources: FDA Advisory Science Board,News Report Nov, 2007,JAMA, NEJM 2008
NAT. ACADEMY OF SCIENCES, INST OF MEDICINE
With all this increased public awareness it makes sense for the FDA to put it dedicated people back in charge of regulating Big Pharma. Will it happen? Your guess is as good as mine. Money talks.
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Thursday, May 1, 2008
Source: NEJM 7.19.2007
Our great grandparents had rickets. Once we fortified our food with vitamin D we thought we had the problem solved. Hah! Vitamin D deficiency is still very common in kids and also adults. A deficiency in pregnancy results in growth retardation, skeletal deformities, and hip fractures in old age.Deficiency also causes bone weakening, bone pain, muscle weakness and increases the risk of fractures.
Most cell in the body have vitamin. D receptor that can convert circulating vitamin D to 1.25di OH vitamin D. This vitamin plays a role in many chronic illnesses including cancers, autoimmune disease, infections, and heart disease.
HOW DO WE GET VITAMIN D
Sunlight, diet, and supplements are sources for vitamin D. Sunlight coverts cholesterol to vitamin D. Fortified foods offer a minimum amount of vitamin D. Ironically, Europeans do not fortify their foods. Oily fish are a great source of vitamin. D. Vitamin supplements are another source with vitamin D2 and D3 available. Two kinds of vitamin D. Vitamin D2 is made from yeast and Vitamin D3 is made from lanolin.
The liver to 25 OH vitamin D then metabolizes the vitamin D that is made. This is then destroyed by the kidney. Calcium and phosphorus are absorbed better with high levels of vitamin. D. In fact, only 10% of the calcium ingested is absorbed if there is a deficiency of vitamin D. A level of 150mg indicates too much, this is very rare.
Over one billion people are deficient. 40-100% of all Europeans are deficient. as are 50% of women with osteoporosis taking who are taking osteoporosis medication. Fifty percent of Hispanics and blacks are also deficient as are one third of healthy college students. People close to the equator who soak a lot of sunlight have great levels of vitamin D.
Ironically, in the Middle East, people hide and shield themselves from the sun, and as a result have low vitamin D levels. At risk are even pregnant women who take their vitamins, eat fish, and drink milk. Seventy five percent of these pregnant woman and 89% of their offspring are deficient in vitamin D.
93% of patients admitted to an emergency department with muscle aches and bone pain have a vitamin D deficiency. They often are diagnosed with fibromyalgia, chronic fatigue syndrome and depression.
One third of women between 60-70 have osteoporosis and after 80, 2/3 of them have osteoporosis. Half of women who have osteoporosis will get a fracture in their lifetime.
OTHER ACTIONS OF VITAMIN D
Besides maintaining strong bones, skeletal muscle also requires vitamin D to function. Muscle weakness occurs if there is a deficiency. Seniors have decreased muscle strength because of low levels of Vitamin D and consequently have more falls. A dose of 800 IU of vitamin D3 could prevent manyof these problems
Vitamin D decreases cell proliferation in both normal and cancer cells and makes the cells more mature.
Toronto doctor Goodman reported that 83% of the breast cancer patients who had adequate Vitamin D when the cancer was discovered were alive 10 years later, while only 69% of patiients who had deficient levels of Vitamin D on discovery of their breast cancer survived 10 years. This 14% drop in survival is very significant.
Vitamin D increases insulin production and also helps the heart muscle to contract better.
WHERE TO LIVE?
Living at higher latitudes increases the risks of disease by 30-50%. Living in upper United States result in more lymphomas, colon and pancreatic cancers, and prostate cancers. Increase sun exposure and higher vitamin D levels result in a decrease in deadly cancers. Vitamin D prevents blood vessel proliferation and can reduce the ability of cancerous cells to survive.
Type 1 diabetes; multiple sclerosis and Crohn’s disease risks are all decreased by 50% in people living at lower altitudes as Florida.
High blood pressure and heart disease rates decrease in lower latitudes. Even heart disease patients have vitamin D deficiencies. One also sees a reduction in rheumatoid arthritis and osteoarthritis in warmer and sunnier states.
HOW MUCH VITAMIN D IS NEEDED?
Without adequate sun exposure, 800-1000IU of vitamin D3 is needed. D3 is three times more effective than vitamin D2, which is found in your common vitamins. Either take 1000 IU of vitamin D3 or 3000 IU of vitamin D2. In pregnancy 4000 IU of vitamin DE3 is advised. Overdose of vitamin D is very hard. A dose of 10,000 IU of vitamin D3 for 5 straight months caused no problems.
SENSIBLE SUN EXPOSURE
Vitamin D is stored in body fat and is released in the winter when vitamin D3 can’t be produced. Exposure to areas of the arms and legs for 5-20 minutes between 10 am and 3 pm should result in plenty of vitamin D. The skin can make a lot of vitamin D3 even in the aged, thus reducing the risk of fractures.
Vitamin D deficiency is very very common. A deficiency predicts bone and muscle weakness, and an increase risk for cancers and other chronic diseases. Taking 1100 IU of vitamin D3 reduced the risk of cancer by 75%. Kids need at least 800 IU.
Enjoy your sun and take supplements of vitamin D3 to maintain a healthy body and strong heart and reduce your cancer risk. Also go south in the winter for a while and don’t put your sun tan lotion on for the first 20 minutes of sun exposure.
Blame it all on Henry Ford and the invention of the car. We haven’t been our sunny selves since.
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SOURCES: SCIENCE 4.11.2008 & NATURAL MEDICINE 4.2008
In the 1990s, doctors took dopamine producing neurons from aborted fetuses and injected them into the brains of Parkinsonism patients to replace neurons destroyed by the disease.
Two later trials showed that the surgery had no benefit and even caused involuntary movements in some patients.
Three studies were done recently on 6 brains from patients who had these transplants and found that many transplanted cells identified by their pigmentation and staining for an enzyme found in dopamine production that showed Parkinsonism pathology.
This suggests that the disease can spread from the host brain to much younger neurons with different genetics. The pathogenic mechanism is unknown. Immune reactions to the transplanted fetal cells may be a factor.
Today fetal transplant surgery is rarely done. This puts a question on whether stem cell transplants would work.
Time will tell.
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