Wellness Posts by Estelle Toby

Like Me — More Experts Are Changing Their Mind About Medicinal Marijuana

support@wellness.com — Fri, 23 Aug 2013 00:26:53 Z

Wellness.com - Like Me — More Experts Are Changing Their Mind About Medicinal Marijuana by Estelle Toby

Alright, so I am a cynic. It seems like the -very public change of position of Dr. Sanjay Gupta-, a mainstream doctor who presents mainstream medicine in the media is on the level with religious conversion among the missionaries. Then, only today, I saw -an article by the chief and deputy chief of NORML- — an organization I am also blogging for. Most folks seem to think marijuana should be freely available. I empathize with Dr. Gupta. I used to be anti-marijuana, too — medicinally. I’ve always been a civil-rights activist and supported the right of people to use marijuana recreationally. I thought the medical marijuana movement was just some kids who wanted an excuse to get high. I changed from “against” to “for” because of the same reason that Dr. Gupta talks about. Research. Research done and published worldwide. When I was living abroad, I was convinced that the best (and the best funded) research came from the United States, and I was excited about returning. Now there is no doubt in my mind that the good and valid research that shows the merits of cannabinoids in the treatment of myriad diseases are coming from Israel, Spain, and other non-American shores. Perhaps because of my own multi-country background (France and Canada as well as my native USA), I have always been open to research coming from other countries. They certainly are not stupider than us by any means. Quite the contrary — They are more open-minded. Oh, how I have always believed that freedom of thought was a hallmark of being American. My grandmother of blessed memory always told me people did not have the freedom to worship in Judaism in the then U.S.S.R. and she felt she had to come stateside. Could it be now that scientific freedom of thought is actually easier to come by in other countries? - There is something eerily simplistic about politics and its dominion over science in these United States. The knee jerk right and left have a horrible track record of being wrong and wronger. Decisions have been made about marijuana because of politics while other countries have been heroically proclaiming the abilities of marijuana to heal ailing mice and cells and by inference now and by human research soon, to heal people. Human sufferings are the reason young and idealistic folks choose to go into medicine in the first place. The opposition can always block progress by crying “There isn’t enough research! There isn’t enough data!” Although I enjoy experiments and data, I have always told everyone I am a doctor first, wanting to relieve suffering first, before I look at data. It is time for American medicine to hang its head in shame. The government persists in classifying marijuana as having no medical utility, while every day I see people who thank it for their ability to function, even their ability to be alive. There are none so blind as those who are paid NOT to see — if I may paraphrase a scripture. I am proud, really proud, that I am affiliated, by virtue of -my blog, with NORML-, as cited in the CNN release. The truth is that marijuana is beneficial to many; a truth that the United States government has been systematically blocking without data by claiming it is of no medical use. I believe in scientific research as a way of accessing the truth. This is being done with cannabis research every day. Cannabis is helpful and it helps many. I think the major block in accepting this truth is that the United States has to admit it has made a grievous error. This kind of admission is difficult for the United States. Capitalism, that lofty ideal, has degenerated into knee-jerk politics that seems dominated by greed. I have no other diagnosis. Can we get the United States back on track? Can we enjoy anything like a shadow of the supremacy in science that I longed to return to when I lived and worked in Europe, so many years ago? - I believe the United States can. We have honest idealists. We have people who care for what should be available, what is justified, and what is just plain right. People like the fine folks at NORML. Marijuana is good medicine for lots of folks. Accepting this truth will make the United States stronger. We may be finally moving toward Thomas Jefferson’s ideal of an informed populace. We may be moving towards a medicine that actually relieves suffering.

More Fake Diet Methods On The Market

support@wellness.com — Fri, 23 Aug 2013 00:24:34 Z

Wellness.com - More Fake Diet Methods On The Market by Estelle Toby

I thought that everyone knew by now that if something is a supplement that is supposed to help you lose weight by gulping down a pill, it is going to turn out to be a lie. One of the first things they teach you in debating is that your weakest argument is an appeal to authority. Everyone who follows Dr. Oz has noticed that his recommendations seem to “flip-flop.” Perhaps individual supplements come to him with some inducement to publicize them? Whatever. This stuff does not work terribly well. Garcinia cambogia- is also tamarind, often used in different cultures to aid with weight loss. It is a wildly fibrous fruit, so it fills people up. This seems to be responsible for at least some of the alleged weight loss properties. It may be one reason that despite the use of this fruit in Mexico, it does not seem to have ever really caught on with American tastes. The other principle here that may be related to weight loss is hydroxycitric acid. I first started checking this out when a patient told me about Xango, which was supposed to be made from the juice of the “mangosteen,” which I originally thought was a Jewish mango being cited by someone who could not spell Jewish names. Garcinia mangostana does have hydroxycitric acid. The article cited by Dr. Oz- is concerned with the bioavailability of the compound than the efficacy. With diet, exercise, and this supplement as described, it is estimated (by Dr. Oz from this unavailable article) that an average person can lose 4 pounds per month. Nauseatingly painful mainstream websites for weight loss through diet and exercise suggest -a loss of one to two pounds a week- is what can usually be expected. This can be as much as twice as much as the projected amounts described with hydroxycitric acid. There is now a rash of supplements from green (unroasted) coffee beans that are supposed to be weight loss aids. They do not “boost metabolism;” they do have some hydroxycitric acid which seems to block citrate lyase, which is important in fat synthesis. It helps carbohydrates to get stored as fat. Remember “fat blockers?” The rage for a while, they suddenly disappeared. That seems to be the general idea here. I think it must have been very long ago indeed, for I think in high school or something I briefly took one—I cannot even remember what it was, chemically, and surprise, surprise, absolutely nothing happened. It is really hard for me to get data on this. The FDA does not evaluate nutraceuticals. Safety and efficacy studies seem to have been done by Iovate, a company that makes several supplements with hydroxycitric acid. They are thus “proprietary,” which means private and not published in medical journals, which means I am even less likely to believe them than I am anything that is published in a medical journal. According to these folks, in 2009, Iovate voluntarily pulled these products from the shelves because of -liver problems, seizures, and rhabdomyolysis. Here is a more complete report -of the recall. It does not seem to work, at least not very much, and it might be harmful, and Dr. Oz recommends it. I say, save your money. Avoid the processed foods that are keeping you overweight, and food manufacturers wealthy. The answer is simple; simple foods,with little or no processing, that are consistent with your ethnicity. Of course, you can read more about my personal journey from illness and obesity to naturally healthy in my book, -This Is NOT A Diet Book. Or just keep reading this blog – I have lots of good advice for those who are serious about making positive changes in their lives and health.

Anti-Obesity Discrimination and Obesity Treatment

support@wellness.com — Fri, 23 Aug 2013 00:22:36 Z

Wellness.com - Anti-Obesity Discrimination and Obesity Treatment by Estelle Toby

I am an expert on this — -Anti-overweight discrimination. First, from my practice. I remember a woman in her forties I saw in Oklahoma for a routine antidepressant renewal who told me that she had a cardiac condition and had been to her primary physician (this is back in the prehistoric days when I took insurance) and he had told me it was her own fault she was overweight and she was risking her life by doing nothing about it. She was not suicidal. She told me she would never see that doctor again. And she was not going to take any heart medicine. I renewed her routine and (allegedly; at least, then I believed it) cardiac side effect free antidepressant. I pleaded and even cried. I told her life was precious, and heart problems were dangerous. No. “When you have been hurt you have been hurt. I am a God-fearing woman (I heard this plenty in Oklahoma) and when I join God I will join God. I am not going to another doctor.” - I tried hard, talked a lot, documented a lot, and — in what then would have been considered a creative, even wildly original move — told her to look at one of those pages with teency-tiny ID photos of the primary care doctors available in her insurance and pick the fattest one she could find. Nothing worked. I could identify with her pain-, told her I had been called “fatso for a big part of my life. Nothing worked. I left Oklahoma and have no idea if she is still alive. The things reported in the New York Times article are far more subtle. People are denied surgery for being overweight. Such was not the case in either France or America when I was actively performing surgery. It meant the assistant (me) threw her whole (sometimes considerable) weight into holding the retractor, to pull back whatever flesh happened to be in the way. Maybe there are emergency procedures treated more tenderly. I don’t know any more. I do know, from my own observations and experience, that obesity is not a person’s “fault,” it has to do with genetics and overprocessed foods. I avoid doctors for numerous reasons, but I can tell you that- before and after a weight loss of about 200 pounds- I was treated first poorly then nicely in department stores and other public places. My father of blessed memory hated people from Yale because of the primordial Harvard-Yale rivalry, but he did think anyone with a Jewish surname was smarter. I actually -read this article- and was outraged. (Note: this link is a PDF file and you must have the free Adobe Acrobat reader installed to read it.) - Yes, obesity is certainly a factor in all of the major causes of death in America. Unfortunately there is a belief in America that when there is a problem, you make more rules and give people more instruction so you can fix it. Not if you do not have underlying science. A Yale professor with a Jewish surname wants to teach people to limit portions and other things he lists to eliminate childhood obesity. We all know how much children, and adults for that matter, love to work around the rules. People worship the football player who gets his way without a penalty flag going down. Even a stellar example such as my husband remembers a childhood fantasy about getting beans up his nose since his grandmother of blessed memory told him not to get beans up his nose. Even me, myself, I remember when my parents told me never to eat non-kosher seafood in Boston — lobster capital of the world — and the first time I got to buy my own lunch at Boston University, I savored a lobster roll at a hole-in-the-wall diner on Commonwealth Avenue. The only thing I can think of right now that would give me more pleasure than that moment, would be beating up this Jewish Yale professor, which I am not stupid enough to do physically (I would end up in jail) But I am doing ideologically. This man is simply not smart enough to question the power of his own, or any authority. Any mother who has tried to make children eat what they do not like is smarter than him. Better at observing human behavior. The processing of food, the poisoning of American food, is evident to anyone who observes, as I have . Everyone except him knows diets don’t work. Everyone in the rest of the world knows there is more obesity when American style food moves in. He is the caricatural ivory tower academic who knows nothing of life. America deserves better. America deserves me, and the -American Natural Health Initiative. I have moved far beyond my academic appointments. I need help and friends but I am the doctor who sees the truth, and helps myself and others. Copyright 2013 Estelle Toby Goldstein, MD -

Why I Have Not and Will Not Take Tamiflu

support@wellness.com — Fri, 23 Aug 2013 00:20:15 Z

Wellness.com - Why I Have Not and Will Not Take Tamiflu by Estelle Toby

This story does not start with “I was minding my own business, surfing the internet.” - I was seeing a deeply suffering patient with terminal cancer and I was sneezing. I have a bunch of seasonal allergies and I treat them naturally with -Quercetin- and related compounds, a bioflavonoid, unpatentable, because I would have to eat a lot of oranges to get enough. Still, I will admit to the occasional sneeze, followed by the use of a tissue. She stroked my arm. “I hope you take good care of yourself, you are such a sweet lady. Maybe you need some Tamiflu or something.” I promised her I would look into it, taking her concern for my well being as a sign that she liked me. When people like me that much, it gratifies me and tells me I am doing the job of doctor pretty well, or at least better than the generally non-emotional most, and I am happy. Out of sheer curiosity, I actually checked into Tamiflu. I was shocked to learn that not only was it being advertised for the general public, but our beautiful Center for Disease Control is promoting it in -public service announcements. You can also read the -script. Note, this is being advertised — yes, advertised — as a first line defense against flu, and for those with minimal symptoms. All of this is delightfully -reviewed- by Shannon Brownlee and Jeanne Lenzer in the Atlantic. They are certainly both on the money here. Roche, the maker, has apparently withheld data; the stuff -does not work. People usually don’t put stuff in the British medical journal unless they are pretty sure it is true. The data seems to have been reviewed by the Cochrane Reviews. I love these guys and gals, and discovered them years ago through a journal called “-Bandolier-;” evidence based medicine. What a dishy concept. They’re Brits, of course. Why did we have that revolution again? - The Cochrane folks have -plenty to say- about neuraminidase inhibitors, the whole class of meds that includes Tamiflu. You can also review the -original abstract. It does not take thirty years of medical practice to figure out it does not seem as if Tamiflu or things like it work, and that the Roche Company seems to have withheld data. Any representatives from Roche must have given up visiting me years ago because I cannot remember any. I do remember my preceptor from my year of psychopharmacology fellowship, who was retired from Roche Labs on the east coast. Whenever I asked him what it was like, he would roll his eyes heavenward before responding. I suppose no drug company would have been very much different. People in business are supposed to maximize profits for stockholders. I am starting to get a feeling they feel no such obligation to help patients.

Patients Avoiding Hospitals and Doctors

support@wellness.com — Fri, 23 Aug 2013 00:15:18 Z

Wellness.com - Patients Avoiding Hospitals and Doctors by Estelle Toby

I remember the first time I saw a- young patient with older person’s diseases. I was in a public clinic, not far from the industrial waterfront in California. She was 24 years old, weighed 380 pounds, had already had what she claimed was a “slight” heart attack. She had type 2 diabetes which I thought was virtually impossible to get at such a tender age. She was able to do little other than to shrug her shoulders. She said something about health problems having been in her family. Me, the only thing I could think of was that I was only through 3 years of so of a seven year medical school at her age. I was quite overweight, but if I had been struck with her degree of obesity or her medical problems, I don’t think I would have had the stamina to get by. Sure enough, she was neither working nor going to school. When you are an adolescent, you think you are going to be strong and healthy forever. I remember looking at patients and never thinking I would be as ill as they were. I remember seeing patients in intensive care in comas, never thinking for a moment that I would have three of them in my life before I was able to figure out the hereditary metabolic that had caused them. I chronicled this in -a book about the experience. I lost a large amount of weight and fixed the problem that first hit me when I was age 40. It used to be that people who were going to have heart attacks got them in their fifties. I remember a woman cardiologist, who worked in the emergency room at Massachusetts General Hospital. She told me she had told her mother about how she had spent all of her time taking care of overstressed rich executives in their fifties. Her mother’s response was “Marry one!” Now, according to the research, people get their first heart attack in their thirties. In general, it seems that people are getting sicker when they are younger. This is mostly blamed on obesity. I do not think that obesity is the fault of the individual; it is the fault of a food industry that overprocesses, presumably to earn more money. I think that is a part of the American way, and something that is amenable to corrective action by a populace who will realize and know. I followed a bunch of links to try and figure out how increased illness in younger folks and their attitudes about health were shaping what is going on with medicine. People in their twenties do not appear to be interested in health insurance, -even cheap health insurance. If you are healthy with no spouse or kids, well, it just does not look like a good deal. As they say in the guerilla marketing classes, prevention is an awfully tough thing to sell. A single health crisis can cause economic disaster for the uninsured. I do not know how to convince kids in their twenties of this before it happens. I worry less about the insurance companies who may need healthy young folks paying low premiums to support care of the aged. I worry more about the -young people. I can only hope that they will see enough health problems in older members of their families to believe in prevention. So what happens if these young folks actually get something that needs medical care, like a sore throat that won’t go away? They take advantage of a new medical system called “retail medicine.” I have heard a little about it on the fringes, but only recently started to learn about what is happening. More people are using -these health clinics- that are in drugstores or supermarkets or retailers. They are cheaper and their prices are more
“transparent” (read “predictable”). Except for Texas, where such clinics cannot exist without a doctor on-site, the health care provider is usually a nurse practitioner or physician’s assistant, providing healthcare without a physician present, and guided by lists and decision trees about their scopes of practice. I have already heard my share of touching stories about people in such facilities assisting people with strokes and heart attacks get to fully equipped hospital emergency rooms. I must establish that I love nurses and I love Physician Assistants. Any doctor who does not state that they were assisted in their first learning of practical skills (such as getting and intravenous access into a vein) by a nurse or physicians’ assistant is probably lying. I cannot count the number of times nurses or other folks with licenses that did not say “medical doctor” on them helped me learn how to do practical and necessary things. This does not mean that getting everything done at this level of care is the best way. I will also freely admit that I, like everyone else who trolls the internet, tend to read with curiosity things like conspiracy theories or references to allegedly previously -withheld information that are relevant to my interests. There are still hidden costs; insurance may or may not cover, etc. There are maybe referrals for products within the drugstore where the place is located. Family doctors may repeat tests if results are not available. Family doctors may be going broke. 400 doctors a year commit suicide in these United States, and I have seen some recent references suggesting that more of them are smart enough to make it look like an accident. Being a doctor and feeling devalued is not just a feeling. It is becoming, and may already have become, a fact. Has it occurred to anybody at all that the quality of medical care may sometimes be less good in this kind of facility? That missing a diagnosis may be “less important” when the patient visit is a one-time economical move, than it is when you talk to a doctor. Even if you don’t believe that doctors have any extra dedication, you have to believe that they sat through more classes and took more exams. Recently a patient told me she went to one of these places only when she needed an “antibiotic.” Excessive use of antibiotics since their discovery has gotten us to a point where the bacterial organisms we try to kill with them have developed resistances and become harder to kill. Sometimes antibiotic use is not a really good strategy; sometimes, a combination of them is needed to get rid of an invading organism. I don’t know if, for example, the nurse practitioner who sits in this kind of office is ready, willing, and able to make this kind of decision in a way that is good for the patient as well as other inhabitants of the planet. I do not doubt such a person’s dedication nor their practical skills. I have not seen the “decision trees” or lists they use for treating. People need to take as much responsibility as they can for their health care. Thomas Jefferson expressed the idea a long time ago that an intelligent electorate would be the safeguard of freedom. I beg and pray that we have patients intelligent enough to safeguard their own health.

Lady Gaga's Synovitis

support@wellness.com — Fri, 22 Feb 2013 13:43:57 Z

Wellness.com - Lady Gaga's Synovitis by Estelle Toby

Lady Gaga had to cancel some shows because she has Synovitis. Can you get that from wearing raw meat? Just checkin'. Actually, I know a little something about this. Synovitis, I mean. Not the wearing meat part; I much prefer to eat mine.

Go back to me at 18. Yes, I know it was a long time ago. But there are some things you do not forget, like my first days in the emergency room at the ancient and venerated Massachusetts General Hospital. It had been open since 1811. I read the log; the first patient was a French sailor — ships could dock at the front door, then — with what was politely referred to as a "social disease." It was a work-study job assigned to me as an undergraduate, allegedly pre-med, at the sprawling Boston University. They laughed when I said I was going to be a doctor. I took people's wallets from their pockets, looking for identification and insurance cards and I was good at that nefarious profession. I loved the moments when it was quiet up front and I could sneak back to an operating or treatment room, stealing a generally useless tidbit of medical knowledge. Such tidbits seemed so precious then. I remember sneaking back to the cast room when a handsome, muscled, orthopedic surgeon was casting a leg. He was laughing at me, like everyone else. He told me to ask him questions. The lady with fake blond hair, whom he was casting, was laughing, too. "Go ahead, honey. Ask him questions." I asked him, I guess she hurt her knee. "How do you know how high up and how low down to build the cast?" Above and below the injury. Knees were kind of a mess, but you always worried about the articulations above and below. The orthopedist was not particularly articulate. I started thinking that any idiot could be one, and medical school should not be that hard to get into. I thanked him and turned to leave when he hit me with something I have never forgotten. "Casts are easy. Broken bones are easy. The tough stuff is soft tissue. Nobody knows a damned thing about soft tissue injuries. They act like they do, but they don't." I repeated my thanks, and felt bad that I had to slip back to the front desk and the business of who people were and who paid for all this.

Lady Gaga's "Synovitis" is an inflammation of the capsule around a joint, known as the "synovium." I am not sure which joint and not sure anyone but me wonders. I know a lot of people must be losing money because she is cancelling shows, and that probably worries someone. If she had broken something, she would have been immobilized and visibly unable to dance. Shows would have started being cancelled a month or so ago when she actually had the injury. It would have been easy to say she broke her hip or knee or ankle or foot and had to cancel shows for a predictable amount of time. Inflammation is something that is visible when it is on the surface, but damned hard to visualize when it is beneath the surface. Flash back to my first lesson from my very dapper Professeur of Pathologie, who was always groomed like a Parisian male fashion model — which amazed folks because he was North African in origin and I later learned, Jewish. But he was a venerator of Latin and classical terminology, which I loved because I had sat through so damned much Latin at Beaver Country Day School I could speak it fluently. I love it that something this classical made it onto the internet under the rubric "medical news today," but here are, under the special turquoise-marked text, the classical Latin descriptors of inflammation. "The so-called cardinal signs of inflammation are rubor, redness; calor, heat or warmth; tumor, swelling; and dolor, pain; a fifth sign, functio laesa, inhibited or lost function, is sometimes added. All these signs may be observed in certain instances, but none is necessarily always present."

Lady Gaga seems to have lost her function, and it is impossible to tell if she has redness, heat, or swelling; but she's sure got pain. When people start personifying something, like saying the affected organ is trying to get rid of its insult — the sort of thing they are saying here — they are really saying that my orthopedic surgeon was right and nobody knows what the hell is going on with soft tissue injury, anyway.

Far and away the most commonly used anti-inflammatories in our society, both prescription and over-the-counter, are the non-steroidal anti-inflammatories, or "NSAIDs." I once had the unenviable task of presenting them to a class of massage students who did not believe me when I said they could be quite dangerous. "No way," said a veteran attending class on the GI bill. "They give them out like candy in the military." I tried to hide my horror. "You poor guy; did you actually believe everything they told you in the military? They kill about ten thousand people a year from GI bleeding, world-wide. If there is anything else the military told you that might not be true, you can talk to me after class." He didn't. He stared at me kind of funny and just kept walking. Estimates for NSAID-related deaths, as reported here, are higher than what I knew about from the literature at the time. I stopped recommending NSAIDs to my patients several years ago.

If Lady Gaga's physical confirmed the diagnosis, the most potent anti-inflammatory I know — the one I used after dental implants and give to my own beloved husband for any kind of inflammation — is MSM. Yes, even the conservative folks at web.md have something to say. This MSM is a way of getting organic sulfur — attached to carbon and oxygen and hydrogen — to enzymes that help with inflammation. It is the first-pass metabolite of DMSO, which means that it is the product you get when DMSO goes through the liver. It can be taken orally, sprayed on, or whatever; there is lots about it on the internet. I'm not one to give fashion advice, so no further comment on Gaga's meat dress. But I do care about health and wellness, so let me simply suggest we all question authority. Especially when it seems to come from drug companies through doctors, many of whom simply do not deserve the pedestal society has placed them on. They may have some merit for emergent situations. But I question anything I hear from mainstream medicine about chronic disease.

To Aspirin or Not To Aspirin; That Is the Question

support@wellness.com — Fri, 22 Feb 2013 13:42:26 Z

Wellness.com - To Aspirin or Not To Aspirin; That Is the Question by Estelle Toby

Warning: Daily use of aspirin can lead to side effects which may include total loss of impulse control, man boobs, toe hair, and third nipples. Please consult your doctor before taking this and other over the counter medicine.

Well, not really. But your really should know the risks and benefits of anything you take, even if it's over the counter, even if it's aspirin. I have an early memory, and I cannot have been beyond high school or early college, for I was still going to Friday night services with my Parents-of-Blessed-Memory. My father would not let me in the choir with the other retired senior types with weak voices; but, it seemed to amuse him to no end when I out sang them and the cantor from the congregation. The cantor had some kind of a congenital dislocation of the hip and some kind of back pain and I don't know what else. My parents had discouraged my still premature medical curiosity and told me not to ask him.

I remember distinctly the Friday when he told the three of us that his doctor told him to take an aspirin a day so he did not get a stroke, as he was a big stroke risk. We were in the Oneg Shabba, which meant a little wine for many and a lot of sweet cakes for my brother and me. My mother told him to his face to mind his doctor, but the minute he left she told everyone this was the stupidest recommendation she had ever heard. The doctor was probably playing a joke on him and just told him something harmless to get him the hell out of the way. This was long before the internet, but during the time when I was doing a lot of research at the Countway Library of Medicine at Harvard. It was not long after that night at synagogue that I read something about aspirin stopping platelets from aggregating. I once tried to tell my Mother-of-Blessed-Memory, who always wanted to hear what I was reading and learning - although she'd always ask me to "dumb it down" for her. This is obviously how I became pretty damned good at explaining things. She never bought the stuff about aspirin. It made no sense to her, and I only tried to explain it once, before her wincing was plenty enough to make me stop trying.

I should, I suppose, have located and congratulated the cantor's doctor for trying to put something like that into practice. I didn't. I have now lived to see the recommendations for aspirin use go from 80mg to 325 mg for stroke prevention - from a baby aspirin to an average grown up aspirin.

There's been a study done in Australia, ultimately picked up by ABC News, showing that aspirin use in older folks may be associated with macular degeneration of the "wet" sort, a major cause of blindness in older folks. Well, folks over 49 anyway. Egads, I'm ten years past this and still in active denial of aging and trying to pirouette through the living room. This is why medicine is an art, not a science. Flashback to one of my wonderful medical school professors in France, Dr. Jeanne Orfila. She taught me many things, one of which was that the hardest thing to do in the practice of medicine was to read research and decide if and how it should change the way you practice. Flash forward to one of my preceptors in residency, who passed out to a room full of psychiatrists in training, copies of a pharmacology research paper which I thought was particularly useless. When he asked if anyone had anything to say about it, I criticized profusely and said I would not use that data to alter my practice. He looked at me, and asked me where the hell I had learned to do that. Why, in medical school, in France, from a wonderful bacteriology professor. I never even tried to explain she was a female and was twice as smart and worked twice as hard as everyone else. I had stolen the preceptor's thunder.

I found something curious about the ABC News article and chased it back to the original article in the JAMA, Journal of the American Medical Association. There's also editorial criticism, which rightfully brings the findings into question.

Aspirin is an amazing drug, with so many effects on so many organ systems. It affects so many things that it would likely have some trouble getting past the FDA today. It is still primarily regarded clinically as an antiplatelet aggregant; read anticoagulant that works in the really early stages of clot formation - this is a good thing which other prescription drugs seem to do either poorly or with more side effects. Our government has listed a lot of other things it can do. Like inhibiting prostaglandins, which means a lot of good stuff like maybe even helping with the Curse of Eve — menstrual cramps, you heathens — or lowering fevers, etc. How like our western medicine to go on blithely recommending a drug perceived as harmless, because it has been over the counter for so long, with professional organizations recommending higher and higher doses. The Aussies did a good study for JAMA. No matter what kind of study they could have done, it is virtually impossible to prove that anything causes anything. This one is a cohort study that compared folks who took aspirin with folks who did not. They are, clearly, not the same folks. They did something statistically nice with nicely structured questionnaires. Unfortunately, nobody thought of asking why these folks were taking aspirin in the first place. Maybe they had really good reasons for taking aspirin, like having had heart attacks and trying to stay alive. Maybe, then, the risk of macular blindness is less important than a life and death risk. So, not only can we not tell if the aspirin really increased the risk let alone incidence of blindness, but we surely cannot tell whether or not the aspirin is justified. Of course, the individual physician must practice this art the way Dr. Jeanne Orfila said. The answer is, as for everything else, that the liability is on the physician, who should be thinking about how to get a valid informed consent for aspirin from a patient. The physician should be determining a risk-benefit analysis for every patient who is told to use aspirin regularly, and should be communicating this to the patient. There is no time, in general. It just does not happen. Pharmacists may be more available for talking, but they have less liability. More than ever, physicians must be descended from their pedestals and patients must become smarter advocates. Ask for risks and benefits for everything you take. Pharmacy printouts can be a start, but the responsibility is, as always, with the doctors. Case by case decision is needed, even on something as seemingly small and common as aspirin.

How to Employ an Individual with Asperger's

support@wellness.com — Fri, 18 Jan 2013 12:36:33 Z

Wellness.com - How to Employ an Individual with Asperger's by Estelle Toby

When I was an undergrad at Boston University, I took a course in the department of sociology in "medical administration." I was compelled to understand the social context of medical practice, for whatever reason. I remember little of the course itself. There was a very attractive older woman sitting next to me who amused herself by "adopting" me, which she thought gave her a right to criticize my then overweight figure and poor clothes. I remember more about her than I do about the professor, a wacky guy the university had seen fit to import from New Zealand. He had published a couple of relevant papers down there, but was still pretty new to the American health care system. He told us that New Zealand had lots of sheep and was a big wool producer. He talked about this great wool magnate who had this neat wool mill — a big one — and how it was he actually became quite wealthy. This was someone who knew about the tremendously loud machines that were used to process the wool. The wool mill owner decided to hire only deaf people. They asked for little; generally, they had problems finding jobs. They were really happy and thankful to be able to work, so they worked hard. They did not have any kind of a problem with the very loud machines. That struck me so much then that I remember the story now, 50 years later. Even then, I already felt that I would be in some kind of a management position as a physician and could do something that clever, becoming as rich and powerful as that New Zealand guy. The professor had said something about Americans not thinking that way. The opportunity has not really presented itself. Probably the closest I ever came was when I was running the day treatment center at the Veterans Affairs Medical Center in Oklahoma. I had a lot of schizophrenic gentlemen who were not rich in social skills, but many of whom liked computers better than people. Certainly, they related to computers better than they related to people. I tried to get them computers, maybe even a little training.

It is harder to deal with invisible handicaps than it is to deal with visible ones. The person who taught me the most about this was my own Mother-of-Blessed-Memory, who always asked me how to explain my brother's disorder, his Asperger's syndrome, to other people.

I watched the movie "Rain Man" when my brother was still alive. You can watch some of the links for an idea of how Asperger's is portrayed. Because of the magnitude of the celebrities involved, I suppose for many people it is the way they see Asperger's in their mind's eye, even now. The excerpts shown in the story show Tom Cruise taking his brother - Asperger's brother — to Vegas. He uses the "savant" side of this "idiot savant" to attack the tables and win some money. My husband and I took Harry, my Brother-of-Blessed-Memory, to Las Vegas. There were no great table winnings and no fascination with multiple TV screen sports betting rooms - as we had hoped. There was a lot of time in his hotel room eating the pizza we had sent out to get him. As noted by the above information from the Autism Society, "idiot savant" is the archaic word for Asperger's. They are not stupid, but they are socially inept. Generally, they have marvelous kinds of gifts, like calculation or music or any one of a number of others. Some also call it high functioning autism. My Brother-of-Blessed-Memory had a menial job as an in house courier at a financial management company. It hurt his feet to cover all the building with his cart. He was not allowed to wear sneakers. Buying him shoes was a job and a half for my Mother-of-Blessed-Memory, but she did it. I thought less of both the workplace and my parents because Harry's feet always hurt. Mother-of-Blessed-Memory said they needed his salary, and they probably did. They found a job for him where little or no social interaction was required. He had to knock on doors, say hello, and deliver envelopes of various sizes. I thought he was a sort of martyr.

CNN's "Top Story" recently ran a story about a German company who only employ folks with an Asperger's diagnosis to do software testing. The owner got the idea after experience with someone in his own family, deciding that this population was an ideal match for that type of work. He put together a company and hired job coaches to help with customer services. I'm sure there are now many people who are probably happier at work than my brother ever was. I wonder why my New Zealander professor thought, even then, that Americans do not think like this. My guess, if this is true, is that the profit motive outstrips the desire to help people find fulfillment at work. When I think of such considerations, I sometimes feel like a cock-eyed optimist or an out of touch idealist. In putting capitalism or greed or whatever Americans are doing first, we have somehow overstrained humanitarian ideals of maintaining a life that is maximized in quality and longevity.

I can speak only of medical care, the field I know best. I have heard of a few "employ the handicapped" programs. I have never heard about them helping the workers feel important or competent, or about giving them jobs that are suited to their "specialness." It's got me thinking — maybe this is a problem for the American Natural Health Initiative.

A Few Extra Pounds Might Not Be So Bad

support@wellness.com — Fri, 18 Jan 2013 12:33:50 Z

Wellness.com - A Few Extra Pounds Might Not Be So Bad by Estelle Toby

Like many others, I am of the type who has been made to feel less. Less than healthy, less than human; whatever, the kind of feeling that sells diet food and diet plans.

When some of the wire services picked up on the latest meta-analysis about obesity and mortality, I had to smile. I've seen and read so many things about how horrible it is to lose weight, how wonderful it is to be thin; and then, this. Ah, at least a morsel of vindication. It makes me think of a classic Broadway song lyric, from "If I were a Rich Man," in Fiddler on the Roof. "I'd see my wife, my Golde, looking like a rich man's wife with a proper double-chin." It was not that long ago, maybe the 1930s, that a couple of extra pounds said their bearer could afford to eat a little more, to satisfy their own hunger. I saw photos of a woman I met from the Ukraine, from before she made it stateside. To the modern eye, she looks thin and very glamorous. From what she told me, there was at least the worry of starvation. Both metaphorically and realistically, there has always been the idea that a little extra layer of fat protects — physically, from the cold; emotionally, from the attention of men. Such things come out often in psychotherapy. Even in my self-understanding of my own obese state, on at least one level, I was protecting myself from the unwanted attention of men while I was studying my ass off. Literally. The article indexed here is a meta-analysis. I have more and more trouble believing any individual article. I have to check it out, and I've become pretty damned compulsive. I need to know who has funded a study, what the interest is, and what somebody has to prove. It is a lot easier to give some credence to someone who reviews other articles. I know smart people who do this informally and decide whether or not the experts agree. More formally, people jump in quite aggressively with fancy statistics and clump together a bunch of research studies, looking at what is going on across the board as a way of accessing the truth. So there is probably something here that is on the way to an absolute truth. In such cases, one of my favorite preceptors would jump right in and tell me, despite the enthusiasm of me and others, it is almost never possible to prove causality — at least not when you are working with human organisms versus little bitty molecules. We have found, perhaps, an epiphenomenon. Maybe the diminished mortality that comes with being overweight is from something else. Maybe people who are overweight and not obese are more relaxed, or a little more prosperous, or something else. Whatever it is, if it is a couple of extra pounds and not wild obesity, maybe it is not so bad.

Once again, I find myself with a song cue - Allen Sherman's Hail to Thee, Fat Person. When I was little, I got the same thing from my Mother and Grandmother-of-Blessed-Memory that Sherman did. I really believed that I was doing something to keep kids in Europe from starving when I was cleaning my plate. I did inquire about it fairly early, precocious child that I was. I got no logical answer, only that I was "lucky."

It did take a while for me to figure out my own weight loss. When I did, I wrote a book. And nobody can or will make me feel like less or sell me on marketed weight loss boloney ever again.

Teens and Inhalant Addiction and — K2 Spice?

support@wellness.com — Fri, 07 Sep 2012 13:15:07 Z

Wellness.com - Teens and Inhalant Addiction and — K2 Spice? by Estelle Toby

The first time I heard about using empty whipped cream dispensers to get "high" was a long time ago. I was living at my parents' house after I had finished medical school in France. I had done my thesis as quickly as possible, in the fall. My residency was projected to start July first. I promised my parents I would do what I could to earn my keep. I sold kitchen cabinet fronts over the telephone, got involved in a chorus production of "Pirates of Penzance," and substitute taught for awhile.

As a substitute teacher in suburban Boston I was taught everything from senior hygiene to 9th grade algebra. A principal saw me teach 9th grade algebra and told me the heck with the credentials - the way I put across factoring quadratics was good enough for him to take me on permanently. I was leading the class in yelling, singing, and dancing "everybody factor." And they were.

I told him I was going Cincinnati to start a surgical residency. He stared at me in disbelief. I told him I had more important news for him.

Most of my ninth grade algebra class was addicted to whipped cream dispensers. A couple of the kids were working at an ice cream place across the street from the school. They were enjoying the aerosol dispensers of whipped cream - far more when there was no whipped cream left inside. This was a sacrilege to a butterscotch sundae lover such as me. And I knew even then this was not a totally harmless addiction - at least not for long.

I suggested to the principal that the kids needed to be educated about it. He giggled a bit, barely managed to say "thank you," and sauntered away. Forever.

I have since learned these are called "Whip-Its," and I have heard of no adult doing them until...Demi Moore? "Clinging to her lost youth," they said.

Freon addiction is a form of inhalant abuse. It seems that the "high" that is associated with these substances is mostly from nitrous oxide - which is believed to be relatively safe. I mean, this is the "laughing gas" that people get at the dentist. The cases that are most worrisome involve refrigerants, from refrigerators and air conditioners, which presumably have lots of the stuff.

Needless to say, huffing various substances can be a deadly addiction.

Back when I was a resident, we saw young kids "huff" things like acetone and turpentine and the like. I remember people got started with "airplane glue." It had been scary enough when I was little that my Mother-of-Blessed-Memory limited the time my brother and I spent with the "gluing" process when putting models together. These substances were highly addictive and young people died from liver failure. It was sad and horrible.

If you look around online, there is plenty of information directed at parents of teens who are supposed to learn how to detect inhalant abuse in their illustrious offspring.

At any rate, it has also been said that in addition to Whip-Its, Demi Moore was also doing K2 Spice. Most of the pages about it on the internet are about how to get it. It is some kind of incense, sometimes touted as "natural," sometimes synthetic, and sometimes as a substitute for marijuana.

Bunches of research and analyses, mostly performed in Germany, have shown that compounds such as K2 Spice that claim to be "all natural" contain other nasty stuff. Not only do they lack the natural substances projected, but may have all kinds of synthetic "cannabinoids" that often include controlled substances, prescriptions, and "stuff" of all sorts. I can tell you for sure there is no real documentation or studies of effects.

Originally, it seems the idea was to choose substances that would fly "under the radar" so that only legal substances would be involved.

About a year ago, our friends at the DEA did an emergency ban, but I do not know its present state.

If you poke around online, it's pretty easy to find descriptions of what the drug can do. The original idea seems to have given way to something pretty out of control.

I am continuously impressed by what people try to take to get "high." I am negatively impressed by the self-destructive nature of some of our entertainers.

I do not want to visit this world, if I can help it. And I can. Chemical substances are not the best "feel good" route, nor are they a defense for aging. There are healthier ways to achieve these ends. I wish the principal at that high school so many years back would have told those kids that. And maybe somebody should tell Demi Moore, too.