EDITOR’S NOTE
Having survived the Mayans we look forward with optimism, hoping that next year things will improve in our society. The same applies to my professional life; despite widespread support for what I do (Integrative Health,) occasionally ignorance, fanatism, and intolerance rear their unscientific heads (see January blog.) You be the judge: examine, look up the references that are herein listed, a small detail I am sure critics have not bothered to do. But, I am not alone in being the subject of harassment; it turns out that 98% of Family Physicians have reported some form of coworker-perpetrated abuse in their careers. [1] Why? There are many reasons, most of which are apparent to you, if you are even slightly familiar with our Health Care system.
Hugo Rodier, MD
One of the reasons.
Is money of course. [2] The whole system now revolves around specialists who occasionally diminish the value of those physicians, who, not for lack of intelligence or commitment, have chosen a primary care specialty. In my case, being a “forest man, not a tree man,” I chose a generalist approach. Prevention, nutrition and holistic perspectives are best managed as a Family Practitioner. [3]
“According to a developing vision, future primary care will entail teamwork among many types of medical professionals, all motivated by global payment and new emphases on maintaining health, not just treating sickness, and on the community, not just individual patients.” [4]
Despite those predictions, insurance companies still tend to devalue Primary Care doctors, even though they spend as much time caring for patients as specialists do; the former get reimbursed at significantly lower rates than the latter.
Then, there is Big Pharma; it has created the impression that anything non-pharmaceutical lacks evidence and is at best an “alternative” to the real treatment, that is, their pharmaceutical products. This is not true, of course; for example, it has been proven that lifestyle changes alone may reverse Diabetes Type II; [5] drugs do nothing of the kind. They only manage symptoms. It is not a matter of new medicines, but of good medicine. [6]
“The Diabetes Prevention Program studies showed that certain interventions could prevent or substantially delay the onset of type 2 diabetes safely and cost-effectively. But despite the disease’s toll, diabetes prevention is not widely practiced in the United States.” [7]
Then, there is Tamiflu, strongly pushed for the treatment of the Flu; well, it does not work. [8] You are better off taking 4,000 IUs of vitamin D for a year; this significantly reduces the risk of getting the Flu. Of course, some doctors, despite the evidence, will tell you that more than 2,000 IUs will kill you.
One of Big Pharma’s marketing strategies is the practice of dropping off samples at doctors’ offices to promote the sale of expensive, and often less safe drugs that are no better than time-proven generics. Despite claims from involved parties, sample DO influence a physician’s prescribing habits. Consequently, most Medical Societies in the USA have issued warnings about this problem. [9]
Then, there is the uncomfortable fact that over half of “scientific studies” on drugs are tainted by self-interest and biased reporting. [10] Perhaps we need to revisit our love affair with drugs: [11]
“The United States would do well to watch carefully (England) how the “burden of illness” and “wider societal benefits” come to affect pharmaceutical pricing, decision making, and sources of influence over the interpretation of societal value.” [12]
The value of acute treatment, as important as it is, has been over-emphasized at the expense of chronic care by the factors outlined above among many others:
“Factors promoting heavy use of pharmaceuticals include lower diagnostic and treatment thresholds, clinician-auditing and reward systems, and the prescribing cascade, whereby more medications are prescribed to control the effects of already-prescribed medications. We present a conceptual model, the inverse benefit law, to provide insight into the impact of pharmaceutical marketing efforts on the observed trends. We make recommendations about limiting the influence of the pharmaceutical industry on clinical practice, toward improving the well-being of patients with chronic illness.” [13]
Cancer, another example
Sure, we will always need chemotherapy, radiation, surgery, etc. to treat this terrible disease. We are therefore grateful to those oncologists who toil in this arena. But, neglecting nutrition and other non-pharmaceutical modalities that have been well documented to be effective and harmless in the medical literature (see most previous issues of this newsletter) is a disservice to patients. Remember that good nutrition may prevent cancers:
“By making modifications in the diet, more than 2/3 of human cancers could be prevented.. Dietary chemopreventive compounds offer great potential in the fight against cancer by inhibiting the carcinogenesis process through the regulation of cell defensive and cell death machineries. Apoptosis, a form of programmed cell death, plays a fundamental role in the maintenance of tissues and organ systems by providing a controlled cell deletion to balanced cell proliferation. The last decade has witnessed an exponential increase in the number of studies investigating how different components of the diet interact at the molecular and cellular level to determine the fate of a cell. It is chemopreventive agents with promise for human consumption can also preferentially inhibit the growth of tumor cells by targeting one or more signaling intermediates leading to induction of apoptosis.” [14]
The following articles update these concepts:
“The role of lycopene (tomatoes) and its derivatives in the regulation of transcription systems: implications for cancer prevention,”[15]
“Prospective cohort study of tea consumption and risk of digestive system cancers: results from the Shanghai Women’s Health Study,”[16]
“Intestinal Inflammation Targets Cancer-Inducing Activity of the Microbiota,”[17] which means that any degree of gut problems raises your risk of cancer. Remember that most of the immune-detox system is in the gut.
Telegraphed articles
“The Science of Resilience: Implications for the Prevention and Treatment of Depression,” [18]
“Risk for Cervical Intraepithelial Neoplasia Grade 3 or Worse in Relation to Smoking among Women with Persistent Human Papillomavirus Infection;” smoking increases the risk of cervical cancer in women with a positive HPV. [19]
“History of Atopy (allergies) May Predict Serious Adverse Drug Reactions,”[20]
“Mediterranean Diet Tied to Sustainable Weight Loss.” [21]
[1] “How the Medical Culture Contributes to Coworker-perpetrated Harassment and Abuse of Family Physicians,”
J. Annals Family Medicine 2012;10:111
[2] “Money and the Changing Culture of Medicine,” New England J. of Medicine 2009;360:101
[3] ” What Business Are We In? The Emergence of Health as the Business of Health Care ,”
New England Journal of Medicine 2012;367:888
[4]” Becoming a Physician: The Developing Vision of Primary Care,”
New England Journal of Medicine 2012;367:891
[5] “Association of an Intensive Lifestyle Intervention With Remission of Type 2 Diabetes,”
J. of the American Medical Association 2012;308:2489
[6] “Good medicine rather than new medicines,” British J. of Medicine 2012;344:e4417
[7] ” What’s Preventing Us from Preventing Type 2 Diabetes? ” New England Journal of Medicine 2012;367:1177
[8] British Medical J. Epub October 29 2012; Cochrane Study
[9] “The Gift of Drug Samples,” The Hastings Center Report 2012;42(2)
[10] “Industry manipulation of medical science,” J. of the American Medical Association 2008;299:1800, 1813, 1833
[11] “We hate big pharma but we sure love drugs,” Fortune Magazine, 2005
[12] “Determining the Value of Drugs,” New England J. of Medicine 2011;364:1289
[13] “The Changing Face of Chronic Illness Management in Primary Care,”
J. Annals of Family Medicine 2012;10:452
[14] “Specific Plants Protect Against Specific, Not All, Cancers,”
Union for International Cancer Control World Cancer Congress; August 28 2012. Quebec
[15] American J. Clinical Nutrition 2012;96:1173S
[16] American J. Clinical Nutrition 2012;96:1056
[17] J. Science 5 October 2012: 120
[18] J. Science 5 October 2012: 79
[19] J. Cancer Epidemiology Biomarkers & Prevention 2012;21:1949
[20] American College of Allergy, Asthma & Immunology, Annual Scientific Meeting, Anaheim 2012
[21] Epub New England J. of Medicine, October 12 2012
