nos-trum. pronunciation: \nos'-trum\. noun. Etymology: Latin, neuter of noster our, ours.
1. a medicine of secret composition recommended by its preparer but usually without scientific proof of its effectiveness.
2. a usually questionable remedy or scheme.
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Thursday, June 26, 2008

IS EATING SALT AT NIGHT TWICE AS BAD AS DOING ONE OR THE OTHER?

AMA, consumer advocates urge FDA to regulate salt in food.

In continuing coverage from yesterday's briefing, ABC World News (11/29, story 8, 2:25, Stephanopoulos) reported that physicians "have been telling us for years to watch how much salt we take in." On Thursday, "America's most prominent doctors' organization asked the government to join the cause."

NBC Nightly News (11/29, lead story, 3:00, Williams) added, "Salt is in just about everything we eat," although the focus is not on "what you choose to put on your food," but on "what is already in it before we get it." Most of us consume "double what we should, and doctors say it's killing us slowly, contributing to the deaths of" thousands "of us every year."

Doc D: That we eat too much salt is undeniable. That salt is essential for giving food taste is also undeniable: if salt were removed from your French fries, they would taste like fried glue, and potato chips would taste like crackling cardboard. In one sense there is no such thing as a salt-free food: there are Na and Cl ions throughout, just bound differently. So, there’s enough “salt” in the food itself to sustain our nutritional requirement. Food companies and restaurants know that salt contributes to your dining pleasure, and they exploit it. The simplest solution for the concerned individual is to not order those salty dishes, minimize the use of canned foods…and throw away your salt shaker—there’s no need for it. If you did this, you could come close to getting under the recommended 2Gm/day limit.

BUT…you knew there would be one…although the risk of high salt intake is hypertension (primarily), and heart disease and stroke (secondarily), we know a lot more about hypertension today than we did forty years ago. Only about 15% of cases of high blood pressure are “salt-sensitive.”

Study suggests evening, night-shift workers may have increased risk of cancer.

The CBS Evening News (11/29, story 9, 0:50, Couric) reported that a study "from the World Health Organization (WHO) says working overnights can increase the risk of cancer." The finding is "based on research showing higher rates of breast and prostate cancer among shift workers."

NBC Nightly News (11/29, story 2, 2:05, Williams) added, "Some nine million American workers, one in ten, work the evening or night shifts in places like hospital wards, factories, and behind the counter in late-night restaurants." Anchor Brian Williams pointed out that working at night is "a way of life, and the only way to make a living, for millions of people in this country."

According to the AP (11/30, Cheng), the night shift joins "UV rays and diesel exhaust fumes" as items that are a "'probable' cause of cancer" on the WHO's list of carcinogens

Doc D: I tell you what, if it’s a cancer risk to be up at night, then those people who watch a lot of late night TV are in trouble. To control this risk, let’s have the government shut down all TV viewing after 7PM……not.

The Food and Drug Administration is cracking down on teas, supplements, creams and other products that falsely claim to cure, treat or prevent cancer even though they aren't agency-approved drugs.

The agency has sent 25 warning letters to companies and individuals marketing these products, while FDA officials said the statements made about these products are dangerous because they could prevent a patient from seeking proper treatment for cancer, and could also harm a cancer patient by interacting with other drugs the patient is taking, reported the Associated Press. The letters criticized unproven claims made about these products, including the ability to "destroy the enzyme on DNA responsible for cancer cells," and the power to "neutralize" carcinogens. The ingredients of these unproven treatments include bloodroot, shark cartilage, coral calcium, cesium, ellagic acid, and a variety of mushrooms, among other products, the Associated Press added.

Doc D: Lydia and I went on a nature walk some weeks ago where the guide told the group as gospel truth that berries from escarpment cherry prevent heart attacks, eating liver prevents cancer, and chewing prickly pear cures diabetes. I’m astonished at the nonsense that gets passed around, and how strongly people believe it. Montaigne once said that “no belief is more strongly held than that about which people know the least.”

I’ve never come across a good study that tests saw palmetto, or St. John’s wort, in a controlled fashion. And I don’t expect there to be, until we extract the pharmacologically active substance from the hundreds of other compounds in these products. We DO have a few studies that show the harm some of these “natural” products cause, in one notorious case the harm was urethral cancer.

I don’t condemn all natural and complementary remedies, but just remember that hemlock is natural.

Opinions are entirely my own. Quotations from Kaiser Daily Health Policy Report ( © Kaiser Family Foundation), AMA Morning Rounds (© U S News Custom Briefings), and PND News Briefs – Texas Edition (© Physician’s News Digest)

Doc D

Tuesday, June 24, 2008

Doc D Rises From the Ashes

I’m going to start commenting again. If you don’t want to receive, please let me know…it won’t hurt my feelings at all.

Lack of Health Insurance for Many U.S. Residents 'Merely a Symptom' of Larger Problem With Costs, According to Opinion Piece

The major presidential candidates have "talked frequently" about proposals to expand health insurance to more U.S. residents but have failed to "recognize that lack of coverage is merely a symptom of a larger problem: the high cost of medical care," Dwight Bartlett, a former Social Security Administration chief actuary and a former Maryland insurance commissioner, writes in a Baltimore Sun opinion piece

Doc D: This is an important point. I find that ALL of the candidates, in their rush to provide benefits for the uninsured (to get elected, of course), have not addressed the underlying problem: people are uninsured because it costs too much. Folks think “if I can just get coverage, things will be OK.” But won’t the costs then keep climbing? Each candidate has a cost-control idea, but none get to the root of how cost is driven, just nibbling at the edges like we did in the 90’s. And, if the government pays for coverage, they will get the money from…you…through taxes. If you can’t afford it now, but still have the choice to choose less, what will it be like when the Fed saves you HAVE to pay whatever it costs?

I want to see a plan that gets at the root of ALL our healthcare system issues: coverage, cost, and access.

BTW, in Massachusetts, which passed an attempt at near-universal coverage into law, the problems are emerging: cost is still rising at double-digits, and access is falling (i.e., can I get an appointment when I want it?)

House expected to vote on Medicare bill this week.

In continuing coverage from previous editions of Morning Rounds, Congressional Quarterly (6/21) reported that the "House is planning to vote on a 'modified' version of a Senate Medicare bill early [this] week," according to a House Democratic aide. The legislation is "based on a bill by Senate Finance Committee Chairman Max Baucus (D-Mont.) to replace deep cuts to Medicare's physician rates, with 18 months of stable payments." While Sen. Baucus's "bill has yet to pass the Senate," CQ pointed out that it "was unclear if the House was moving alone, to put pressure on the Senate to complete a Medicare package, or if the legislation was the product of a deal struck after several days of negotiations between key players in both chambers."

Doc D: In the late 90’s a law was passed to cut Medicare reimbursement to doctors by over 10%. Congress has had to postpone that cut several times in order to ensure that physicians won’t stop seeing Medicare patients. Some doctors got fed up with government reimbursement a long time ago, and don’t accept new Medicare patients already. I suspect that many more will do so if Congress doesn’t fix this situation. Time spent in administration is about 15% now, rising every year, and reducing appointments available.

Once again the issue is cost, not coverage. In other countries with universal coverage, cost is controlled by rationing care to the population.

California Supreme Court to decide if physicians can refuse to treat patients for religious reasons.

The Washington Post (6/19, A2, Surdin) reported that California's Supreme Court "will decide...whether doctors can refuse to treat certain patients for religious reasons." The case involves a lesbian couple who 10 years ago "was trying to conceive." The couple said that "doctors violated [the couple's] civil rights because they refused her a fertility treatment." The "two doctors and their employer, North Coast Women's Care Medical Group, say they denied...treatment because it is against their Christian beliefs to perform insemination on unwed women, whether heterosexual or lesbian." According to University of California-Berkeley professor Joan Hollinger, "The case raises a whole series of questions about the basis" on "which people can be denied medical treatment, particularly the extent to which gays or lesbians could be denied access to reproductive technology."

Doc D: This is interesting. It comes up in the context of a lesbian couple, but there’s an underlying issue. No matter for whom, is fertility a “necessary” treatment (that is, what disease does it treat?) and, if so, is there a “right to conceive” in the same way we think of a right to life, liberty, etc? This is important in itself, but it bears on whether the doctors and hospital are “refusing to treat”. As a doctor I have NO obligation to treat where there is no harm to the individual without it. Is lack of conception a “harm”?

Anyway, this is one of those philosophical things that I think are fascinating and my family thinks are silly.

BTW, the United Nations published a document of Universal Human Rights some time ago. If I remember correctly, there were 29 of them…one of which was the right to marry. This might be a difficult right to enforce if no one wants to marry you.

Opinions are entirely my own. Quotations from Kaiser Daily Health Policy Report ( © Kaiser Family Foundation) and AMA Morning Rounds (© U S News Custom Briefings)

Doc D

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