Thursday, February 23, 2012

COMPUTER AS BLESSING AND CURSE

I have a question for you. A computer-genius friend is designing an electronic medical records system for a clinic—not only the hardware and software, but the entire setup. Where do patient and practitioner sit? When should record-keeping take place? How can practitioner view and enter material without it interfering with their personal contact?


I love EMRs. They provide maximum info quickly, ideally are retrievable anywhere, and don’t involve illegible scrawl. But as used, they can have drawbacks. Patients have lamented to me that their doctor no longer faces them, and instead shows them his/her back while typing on the laptop, as though the EMR is more important that their contact together. And I’ve heard from docs that some EMR software requires so much input from them that it steals time from their presence with the patient.


What’s been your experience? What do you recommend as a way to both keep a thorough, accessible record and a close therapeutic relationship? 

Saturday, February 18, 2012

DO WE HAVE A PILL FOR YOU!

I’ve written here several times about the fifth edition of the psychiatric Diagnostic & Statistical Manual of Mental Disorders (“DSM-5”), to be published next year. Outraged criticisms of its proposed changes seem to fly at it daily. There’s a decent online review of some at (http://www.huffingtonpost.com/allen-frances/dsm-5-press_b_1272068.html?ref=health-news&ir=Health%20News). The author, Allen Frances, MD, is Professor Emeritus at Duke University and former Chair of its Department of Psychiatry. I suppose he knows something of the subject, as he was Chair of the DSM-4 Task Force, editors of the current edition.


The most common criticism is that DSM-5 will radically expand the boundaries of psychiatry, medicalizing normality and thus leading to unneeded and harmful treatment. For example, adults who exhibit only three symptoms instead of the current six could be diagnosed with Attention Deficit Disorder. And much of normal grieving will be considered a psychiatric disorder.


Over the past forty years, psychiatry has drifted increasingly from psychotherapy to psychopharmacy. The manufacturers of psychiatric drugs would love to see increments of normal behavior get labeled abnormal. “You’re not just anxious, you have a chemical imbalance, and we at Avarice Pharmaceuticals have just the thing for you, SerenetinTM. Ask your doctor.”


One wonders, then, whether the twenty-nine DSM-5 authors might have come under the sway of drug pushers. I suggest you check for yourself. There’s a list of them along with any industry connections at http://www.dsm5.org/MeetUs/Pages/TaskForceMembers.aspx. I explored the first eleven on the list and stopped there, as I have a life to live, too. Of those eleven, nine list various associations with pharmaceutical companies, as consultant, stockholder, or grant or honorarium recipient.


Forty years ago, these associations would have been considered unethical. In fact, some universities are now banning them. Far be it from me to disagree with Mitt Romney, but I just don’t believe corporations are people. Unlike human beings, they don’t give up or retire or die. They’re unrelenting. Avarice Pharmaceutical's foot is not only in the medical door, but its reps have been lounging around the living room for decades now. We’re so used to their presence that we put up with their conniving and greed, and seem no longer able to show them the door.


For those of us who like to get drugged so we can pretend that everything in our life is okay, this system works. The rest of us, though, would do well not to inform our psychiatrist that we’re grieving. 

Tuesday, February 14, 2012

OCCUPY YOURSELF II

When I recommended Occupying Yourself in my last blog post, what I meant was taking charge of your own health—not particularly to avoid disease and death, but because it jolly well feels good, and in addition elevates society.

Evidence is accumulating that our most potent medicine may not be any pharmaceutical, but the choices we make that raise life quality. Last week, at the Integrative Healthcare Symposium in New York, Dr. Dean Ornish described research he and colleagues published in this field (http://www.huffingtonpost.com/2012/02/12/dean-ornish-integrative-healthcare-symposium_n_1270412.html). (Maybe you remember Dr. Ornish. He was lead investigator in a study a few years ago which showed that a program of meditation, diet, exercise and support not only halted, but reversed coronary artery clogging. Ornish’s program, at almost negligible cost per patient, outperformed multiple coronary bypass operations that run $100,000-plus.)

Dr. Ornish has now extended this approach beyond coronaries, into chronic disease in general. "Seventy-five percent of the $2.7 trillion in annual health care costs, which are really 'sick care' costs,” he told the symposium, “are from chronic diseases that can be largely prevented, or even reversed, through simply changing diet and lifestyle."

Prostate cancer is one clear example: since most of these tumors are slow-growing, most men are more likely to die with prostate cancer than from it. Because of this, the U.S. Preventive Services Task Force (an arm of the U.S. Dept. of Health & Human Services) recently recommended against screening for the disease. Men who are found to have prostate cancer suffer pressure to treat it even though treatments leave many impotent, incontinent, or both, and even though only two percent of men who are treated for prostate cancer live longer. Dr. Ornish and colleagues recently showed that comprehensive lifestyle changes may slow, stop, or even reverse early-stage prostate cancer.


Or consider diabetes. If current trends go on unabated, fully half of Americans will have type two diabetes or be prediabetic by 2020, at a cost to the U.S. healthcare system—that is, to us—of $3.35 trillion. You probably know that the prime cause of type two diabetes is behavior, specifically overconsumption of carbohydrates. Said Dr. Ornish, "The [causes of most chronic diseases] are primarily the lifestyle choices we make each day—what we eat, how we respond to stress, whether or not we smoke, how much exercise we do, and how much love and support we have."


Why did our national health plummet so remarkably over the past thirty years? Was it from a communist conspiracy? Al Qaeda? No, it was our own habits. We don’t exercise, we consume non-nutritive, processed foods, and we permit ourselves to be assaulted by toxins and carcinogens galore. Maybe we turn a blind eye to this cultural decay because so many of us are materially saturated, and if that’s so, we’ve bought ourselves a truly Faustian bargain. Behaving otherwise—reclaiming our bodies, our communities, and the national quality we deserve—must begin with individual renovation. That’s what Occupy Yourself means.

Saturday, February 11, 2012

OCCUPY YOURSELF

Since posting “Go Check Your Shampoo Label,” I’ve heard concerns from a number of folks, online and offline. Of course, we’re not only talking about parabens in shampoos, but the entire sea of synthetic chemicals in which we’re immersed—known and potential toxins in our personal products, food, air, water, building materials, and pharmaceuticals. What can we do about it?

Well, we can contact our congressional representatives. The problem with that, though, is that so many of them aren’t our representatives anymore. My hundred dollar campaign contribution doesn’t influence them as much as the hundred thousand dollars handed them by Avarice Unlimited and Carcinogens-R-Us. Did I say “hundred thousand?” Lordy, that’s just a tip these days. That is, I’m sorry to say, we’ve pretty much lost our democracy.

On the other hand, The Market really does work. If we want toxic products to go away, we need only buy healthy ones instead. That means doing our individual research, which isn’t easy, yet more and more a survival requirement. 

The industries that peddle toxic crap or oppose honest labeling need their products boycotted. For example, I wrote to Yoplait last year, asking whether their yogurt is made with milk from cows fed bovine growth hormone. They replied, “Studies show BGH is harmless to humans.” I take that as a “yes.” OK, no more Yoplait for me.

Government being useless, it’s up to every single one of us to get educated and act. To promote this notion, I’m developing a strategy:
OCCUPY YOURSELF.

Maybe you’re tiring, as I am, of waving a sign from a freeway overpass or getting tear-gassed on city streets. Though that might be useful in organizing opposition to the sick-making corporocracy, it’s starting to feel quixotic, and in need of a Next Step. OCCUPY YOURSELF means realizing it’s up to us to feel our anger and frustration; decide that this system’s material rewards are chicken feed compared to its injury to our souls; unplug the TV, the corporate spigot into our homes; and behave as though every act is a vote.

It works. For example, for years now our family hasn’t purchased any product whose ingredients include high fructose corn syrup. We’re not the only ones. Evidently a lot of folks have become aware of the link between HFCS and type two diabetes. The Corn Refiners Association, which had promoted it as a “natural” product, recently petitioned the Food and Drug Administration to start calling it “corn sugar,” evidently hoping we might miss that when we read labels. So they’ll push “corn sugar” till buyers catch on, then maybe try “maize sucrose,” but sales will continue to drop until this nonfood finally vanishes from the market.

In becoming more healthily proactive, we’ll be fulfilling the prophecy of John Knowles, M.D. (1926-1979), who was president of the Rockefeller Foundation and Medical Director of Massachusetts General Hospital:

 "The people have been led to believe that national health insurance, more doctors, and greater use of high-cost hospital-based technologies will improve their health. Unfortunately, none of them will. The next major advances in the health of the American people will come from the assumption of individual responsibility for one's own health and a necessary change in the life style of a majority of Americans."

Monday, February 6, 2012

GO CHECK YOUR SHAMPOO LABEL

Research published last month in the Journal of Applied Toxicology (http://onlinelibrary.wiley.com/doi/10.1002/jat.1786/abstract;jsessionid=D715345619D8FCC958CF30A4C10424A3.d01t04) indicates I’ve been right to boycott products containing parabens.

Examining human breast tissue collected from forty mastectomies for primary breast cancer between 2005 and 2008, scientists found parabens in virtually all samples. Paraben levels were highest in the upper-outer breast quadrants, where a disproportionate incidence of breast cancer occurs.

The technical name for this class of chemicals (including metaparaben and propylparaben) is para-amino benzoic acid. My inner cynic, forceful as ever, told me manufacturers changed its name to “paraben” a few years ago, when the public was beginning to realize benzoic acid was carcinogenic. “Paraben” is, after all, a friendlier name, more like something in your spice rack: a spoon of curry, a pinch of paraben. 

Parabens are in many shampoos, moisturizers, shaving gels, personal lubricants, pharmaceuticals, spray tanning solutions, cosmetics, toothpastes, and processed foods. Serving as preservatives, parabens extend shelf life, not yours.

Does this report mean these cancers were caused by parabens? Not necessarily, but the association is too convincing to dismiss. For some reason incomprehensible to my Canadian relatives, we Americans don’t mind ingesting questionable chemicals until they’re absolutely proven poisonous—not easy to prove, considering cancer’s long gestation, our concurrent exposure to thousands of chemicals, and the FDA’s domination by a paraben-pushing industry. The Canadians have incorporated what they call the “Precautionary Principle” into law. Viewed through this lens, chemicals must be shown to be safe before they’re allowed into the market. So as you might expect, not as many make it as in the U.S.

My point here isn’t to legislate against carcinogenic chemicals. That window’s closed. The people who make a buck off them will bribe—excuse me, I mean lobby—legislators to keep them legal. I’m only telling you this so you’ll consider activating your own Precautionary Principle, and decline buying toxins, period.