In 2001 the Institute of Medicine published a scathing report on our broken Health Care system. You can read all about it in the book Crossing the Quality Chasm. Before that watershed pronouncement very few doctors believed the system to be dysfunctional and toxic. There are now many opinions why this is indeed the case. Here is mine.
Our politicians, the media, and institutions no longer serve us, but those who bankroll them. For instance, no article on the harm of pharmaceuticals is ever highlighted by news channels. This sad state of affairs is perpetuated by an educational system that turns students into cogs in a consumerist society. Politicians are now beholden to the corporations that finance their campaigns, the same ones that prefer a non-thinking labor force. Why would health corporations’ self interests be an exception? The only way out is to teach students LOGIC to think for themselves, to encourage creativity, instead of rote memorization. The latter perpetuates the mindless regurgitation of ideologies that only serve those who have managed to control the institutions that were first meant to serve the public.
Hugo Rodier, MD
EDUCATION ARTICLES
Deprivation of liberty in healthcare, BMJ 2014;348:g3390
Activating patients to manage their health can improve outcomes, study says, BMJ 2014;348:g3395
Unearthing democracy’s roots,J. Science 17 Mar 2017 : 1114-1118 In some ancient Mesoamerican societies, rulers shared power and ordinary people had a voice.
Fortune favors the well read, J. Science 10 Mar 2017 : 1090
Higher education protective of cognitive decline in early aging, International Conference on Alzheimer’s and Parkinson’s Diseases and Related Neurological Disorders 2017.
The physician of the future: More like da Vinci, AMA’s Accelerating Change in Medical Education Consortium in Chicago, 2016. http://www.ama-assn.org/ama/ama-wire/post/physician-of-future-like-daVinci?&utm_source=BHClistID&utm_medium=BulletinHealthCare&utm_term=100616&utm_content=MorningRounds&utm_campaign=BHCMessageID
GUT UPDATE
Antibiotics in Pregnancy Increase Children’s Risk of Otitis Media and Ventilation Tubes, J. Ped 2017;183:153
Long-term use of antibiotics and risk of colorectal adenoma, J. Gut EPub April 4 2017
The role of the microbiome in disease: implications for treatment of IBS, J. Fam Practice 2017;66:s40
The Gut Microbiome and Its Role in Cardiovascular Diseases, J. Circulation 2017;135:1008
Substituting whole grains for refined grains in a 6-wk randomized trial has a modest effect on gut microbiota and immune and inflammatory markers of healthy adults, Am J Clin Nutr 2017 105: 635
High-Fiber Diet and Acetate (vinegar) Supplementation Change the Gut Microbiota and Prevent the Development of Hypertension and Heart Failure in Hypertensive Mice, J. Circ 2017;135:964
MORE ON EGGS BLOG POSTED APRIL 24 2017
It’s hard to believe that circulatory problems are due to refined sugars, instead of natural fats. You really should study this issue on your own (see above). Glycation End Products are oxidating, inflaming metabolites produced by our cells when we eat refined sugars, and Trans fats. Check it out:
Advanced Glycation End Products, Oxidation Products, and the Extent of Atherosclerosis During the VA Diabetes Trial and Follow-up Study, J. Diabetes Care 2017 Apr; 40 (4): 591
Longitudinal association between fasting blood glucose concentrations and first stroke in hypertensive adults in China: effect of folic acid intervention, Am J Clin Nutr 2017 105: 564
Rates of hospitalizations for heart attacks, strokes lower where trans fats are banned
“The New York Times (4/12, Bakalar, Subscription Publication) “Well” blog reports that research published in JAMA Cardiology suggests “laws that restrict adding trans fats to foods have had immediate beneficial effects on heart health.” The AP (4/12, Tanner) reports that investigators “examined hospital admissions data from 2002 to 2013 in 11 New York counties that adopted bans and in 25 counties that did not.”
Reuters (4/12, Seaman) reports, “After three years or more, the combined rate of hospitalizations for heart attacks or strokes was about 6 percent lower in the counties with trans fat regulations.” The study found that “admissions for heart attacks were nearly 8 percent lower in counties with restrictions.” Meanwhile, “admissions for strokes were about 4 percent lower in counties with restrictions.”On its website, NBC News (4/12, Fox) reports that the FDA “has ruled that partially hydrogenated oils are no longer ‘generally recognized as safe’ or GRAS,” which “means that after 2018, food manufacturers would have to ask the FDA for permission to use them in food products.”
ENVIRONMENTAL HEALTH UPDATE
Pesticides are Associated with Allergic and Non-Allergic Wheeze among Male Farmers, J. Environ Health Perspect; 2017DOI:10.1289/EHP315
Occupational Exposure to Pesticides and the Incidence of Lung Cancer in the Agricultural Health Study, J. Environ Health Perspect; 2017DOI:10.1289/EHP456
Pesticides speed up puberty in boys, The Endocrine Society Annual Meeting, 2017
Identifying Subpopulations Vulnerable to the Thyroid-Blocking Effects of Perchlorate and Thiocyanate, J Clin Endocrinol Metab jc.2017-00046. 20 April 2017. People 12-21 years old are more susceptible to chemicals that damage thyroid.
Desinfectants and sanitisers associated with thyroid cancer, http://bit.ly/2lmoJQV J. Occup Environ Med 2017
Spinal manipulation therapy may provide improvements in function for people with lower back pain, review indicates
“The San Diego Union-Tribune (4/11, Fikes) reports, “Spinal manipulative therapy, including chiropractic care, provides modest relief from pain and improvements in function for those with acute lower back pain,” research suggests. In its “Shots” blog and on its “All Things Considered” program, NPR (4/11, Neighmond) reports researchers arrived at that conclusion that after analyzing data from “26 studies involving more than 1,700 patients with lower back pain.” The findings of the review were published in the Journal of the American Medical Association.”
Teaching preschoolers self-control around food, combined with obesity prevention messaging, may not reduce obesity
“Reuters (4/11, Brooks) reports that research indicated “teaching preschoolers to regulate their own behavior around food, combined with obesity prevention messages, did not reduce obesity or most obesity-related behaviors.” Researchers came to this conclusion after testing “two interventions, alone and in combination, embedding the experiment within the federally-funded Head Start program.” The findings were published in Pediatrics.”
Mid-life vascular risk factors may be tied to brain changes that can lead to Alzheimer’s, study indicates
“Reuters (4/11, Rapaport) reports, “Middle-aged people with risk factors for heart attacks and stroke are also more likely to develop changes in the brain that can lead to Alzheimer’s disease,” researchers concluded after examining “data from 346 adults who had been evaluated for vascular risk factors since the late 1980s, when they were 52 years old on average and none of them had dementia.” Then, more than 20 years “later, when participants were around 76 years old, they had brain scans that looked for evidence of Alzheimer’s” in the form of amyloid plaques.
According to MedPage Today (4/11, Fiore), “unlike midlife vascular risk factors, late-life vascular risk factors were not associated with brain amyloid deposition on late-life PET scans,” the findings revealed. The study, which was “supported by the National Heart, Lung, and Blood Institute,” was published April 11 in the Journal of the American Medical Association.”
Experts warn fluoroquinolones (Cipro, Levoquin) can lead to tendon damage
“TIME (4/14, Park) reported that experts are calling for physicians and patients to use fluoroquinolones “more judiciously,” not only to “help control the spread of resistant infections,” but also to reduce “rare cases of severe tendon damage associated with the use of the drug.” While it is unclear “how the drugs contribute to tendon issues,” experts “believe that the antibiotics may affect blood flow to collagen in the muscles.”
NUTRITION ARTICLES
Ginger for dysmenorrheal problems, J. Family Practice News March 2017, p15
Vitamin D for the management of asthma, Cochrane Database Syst Rev. 2016;9:CD011511
Remember when we were told that we needed to increase our intake of fruits and veggies to five servings a day? That distant public health campaign was funded by farmers trying to increase sales. Americans did try; their daily intake went up by ½ serving—from 2 to 2.5. But, the amount needed to be healthy is really more than ten servings a day. Check out this article:
The five-a-day disaster: why the numbers don’t add up https://www.theguardian.com/lifeandstyle/2014/may/14/five-a-day-fruit-vegetables-portion-supermarket
“All of that is good because a daily intake of even 200g, or two and a half standard 80g portions, is associated with a 16% reduced risk of heart disease, an 18% reduced risk of stroke, a 13% reduced risk of cardiovascular disease, 4% reduced risk of cancer and a 15% reduction in the risk of premature death. But the study suggests we should be piling up platefuls of vegetables and raiding the fruit bowl every day if we want the best chance of avoiding chronic diseases or an early death.
“We wanted to investigate how much fruit and vegetables you need to eat to gain the maximum protection against disease, and premature death. Our results suggest that although five portions of fruit and vegetables is good, 10 a day is even better,” said Dr Dagfinn Aune, lead author of the research from the School of Public Health at Imperial. Eating up to 800g of fruit and vegetables – equivalent to 10 portions and double the recommended amount in the UK – was associated with a 24% reduced risk of heart disease, a 33% reduced risk of stroke, a 28% reduced risk of cardiovascular disease, a 13% reduced risk of total cancer, and a 31% reduction in premature deaths.
“And not all fruit and veg are created equal. Apples and pears, citrus fruits, salads and green leafy vegetables such as spinach, lettuce and chicory, and cruciferous vegetables such as broccoli, cabbage and cauliflower were found to be best at preventing heart disease and stroke.
New GP leader calls for rethink of ‘expensive’ five-a-day goal
“To reduce the risk of cancer, however, the menu should include green vegetables, such as green beans; yellow and orange vegetables such as peppers and carrots; and cruciferous vegetables. The researchers did not find any difference between the protective effects of cooked and raw fruit and vegetables. Fruit and vegetables have been shown to reduce cholesterol levels, blood pressure, and to boost the health of our blood vessels and immune system,” said Aune. “This may be due to the complex network of nutrients they hold. For instance they contain many antioxidants, which may reduce DNA damage, and lead to a reduction in cancer risk. Compounds called glucosinolates in cruciferous vegetables, such as broccoli, activate enzymes that may help prevent cancer. Fruit and vegetables may also have a beneficial effect on the naturally occurring bacteria in our gut, he said.
Most people struggle to eat three or four portions a day
“And it will not be possible to bottle the effects of fruit and vegetables or put them in a pill, he said. Forget the supplements. “Most likely it is the whole package of beneficial nutrients you obtain by eating fruits and vegetables that is crucial to health,” he said. “This is why it is important to eat whole plant foods to get the benefit, instead of taking antioxidant or vitamin supplements (which have not been shown to reduce disease risk). The analysis in the International Journal of Epidemiology pooled the results from 95 different studies involving a total of approximately 2 million people. They assessed up to 43,000 cases of heart disease, 47,000 cases of stroke, 81,000 cases of cardiovascular disease, 112,000 cancer cases and 94,000 deaths.
“Aune said more research was needed, but “it is clear from this work that a high intake of fruit and vegetables hold tremendous health benefits, and we should try to increase their intake in our diet. Sarah Toule, from the World Cancer Research Fund, said: “This interesting research shows just how incredibly important vegetables and fruit are as part of a healthy diet. In fact, they’re essential for maintaining a healthy weight, which our own evidence has shown reduces the risk of 11 common cancers.
“People should aim to eat at least five portions of vegetables and fruit a day but the more the better. If people find this hard, why not start by adding an extra portion of fruit or veg a day to your lunch or try swapping one of your naughty snacks for a piece of fruit?”
