Preventative care: Not all it’s cracked up to be
For the second time in as many days I’ve been inspired by a New York Times column. Everywhere you turn it seems, you hear people lamenting that we could reduce health care costs so much if only we were more in tune with preventative care. Everyone pays it lip service, including the two candidates for president who both pride themselves on straight talk. Writes Dr. H. Gilbert Welch, professor of medicine at Dartmouth in today’s paper:
Senator John McCain argues that “the best care is preventative care,” and his health care reform plan claims that “by emphasizing prevention” and other measures “we can reduce health care costs.” Senator Barack Obama’s plan says, “Simply put, in the absence of a radical shift towards prevention and public health, we will not be successful in containing medical costs or improving the health of the American people.”
It may sound like common sense. But it is still a myth.
The term “preventive medicine” no longer means what it used to: keeping people well by promoting healthy habits, like exercising, eating a balanced diet and not smoking. To their credit, both candidates ardently support that approach.
But the medical model for prevention has become less about health promotion and more about early diagnosis. Both candidates appear to have bought into it: Mr. Obama encourages annual checkups and screening, Mr. McCain early testing and screening.
Like most platitudes spouted by politicians, it sounds good. But is it? The idea is, of course, that with all these early checkups, tests and screenings, doctors will discover serious disease in its early stages when treatment is easier and less expensive. Were that all that happened, preventative medicine might be worthwhile. But that’s not all that happens. Unfortunately, today’s doctors use physicals, tests and screenings to pinpoint diseases that aren’t really diseases. And these non-diseases are not inexpensive to treat. Let me give you an example.
I have a friend who recently turned 49. He is to all outwards appearances health as a horse. He hikes, he works out, he plays a lot of golf, always walking and carrying his bag, he isn’t overweight, and he has a good family history. His father died in his late 70s and his mother, age 84, is still living and drives her car everywhere. This guy is your basic active healthy middle-aged male with no obvious problems. Then he goes to the doctor to get a physical exam.
All the tests and screenings come out normal except for one. You probably guessed it. His cholesterol was a little high. At 215 mg/dl it came in over the magic cutoff of 200. And like all ‘good’ doctors, his recommended that he go on a statin drug. So he went on Lipitor. And promptly got muscle aches and felt lousy. He called his doctor about the pain, and his doctor told him to keep on taking the Lipitor. He said the aches should subside with time. So my friend soldiered on and took his medicine. But his pain continued. After several months of this aggravating pain, my friend asked me about it. I was stunned to learn that with his age, condition, and family history, his doctor had started him on a statin. I suggested that he discontinue the drug and load up on some CoQ10, which he did. His muscle pain went away and he was soon back to his old self.
But, he had had the fear of high cholesterol laid upon him. He asked me about it and told me that he was a little worried. I gave him the talk that I have given ad nauseum on the pages of this blog about the lipid hypothesis being only a hypothesis and that cholesterol doesn’t mean squat and that a statin wouldn’t help him improve his overall chances of not dying. He was reassured but not totally convinced. I suggested an EBT scan of his heart for a calcium score, an actual indicator of coronary plaque. We went for it and ended up with a calcium score of zero, which indicates virtually no coronary plaque. The doctor who gave him his physical was treating him for a non-existent disease. An elevated cholesterol isn’t a disease – it’s a lab value.
So, we have a healthy guy who goes in for a little preventative care and comes out with coronary angst and a prescription for a medicine that does him absolutely no good and that even may have been doing him harm. He then underwent yet another screening procedure to allay the fears that had been created by the first round of preventative care. He (or his insurance company: read you and I) paid several hundred dollars for the first go round, another couple of hundred for the three month’s worth of Lipitor, and another $700 for the heart scan. After at least $1500 of someone’s money, the guy isn’t any better off than he was before he went for his physical exam. In fact, he would have been much better off had he never gone to the doctor in the first place.
The above example is preventative care as we know it today. And it doesn’t save money overall; it costs money. A lot of money. Had I not entered the picture, this guy may have been on Lipitor for years at God only knows what cost. Preventative medicine today doesn’t reduce medical spending – it increases it.
As Dr. Welch confirms:
Increasing the amount of testing for an ever-expanding list of problems always identifies many more people as having disease and still more as being “at risk.” Screening for heart disease, problems in major blood vessels and a variety of cancers has led to millions of diagnoses of these diseases in people who would never have become sick.
Likewise, recent expansions in the definitions of diabetes, high cholesterol and osteoporosis defined millions more as suddenly needing therapy. A new definition of “abnormal bone density,” for example, turned 6.8 million American women into osteoporosis patients literally overnight.
These interventions do prevent advanced illness in some patients, but relatively few. Any savings from preventing those cases is dwarfed by the cost of intervening early in millions of additional patients. No wonder pharmaceutical companies and medical centers see preventive medicine as a great way to turn people into patients — and paying customers.
Many of whom pay through the nose for a long, long time.
In a brilliant analogy, Dr. Welch compares early screening for disease to the ‘check engine’ light in your car. When it comes on, it may indicate that a problem exists, but more often than not it comes on due to some trivial cause
like one sensor’s recognizing that another sensor isn’t sensing.
I’ve made many a trip to the mechanic to get my car looked at after the annoying ‘check engine’ light came on, and most of those trips resulted in the mechanic resetting the ‘check engine’ light. Many times the light came on simply because it was programmed to come on when the car reached a certain mileage. Just like we are encouraged to have certain screening procedures when we reach a certain mileage.
If when our own ‘check engine’ light comes on, and we head to our doctor, we would be time and money ahead were we given advice to cut the carbs, get more sleep, and quit stressing. But that’s not what happens. We get our cholesterol checked and thus begins a life-long fight to get it lower, when all it is is a lab result. If you don’t believe me about this, search the comments of this blog using the word ‘statin’ and you’ll see how many people write telling me that their cholesterol was found to be a little high, and their doctor wants them to go on a statin. It’s pitiful. In fact, it’s an outrage.
I’m not saying you should never go to the doctor or never have a screening to see what’s going on. But I do say that you should undertake these procedures only when they provide some value. Colonoscopies are worthwhile because colon cancer, caught early, can be successfully treated. Same with PAP smears and cervical cancer. An EBT scan of the heart for a calcium score is valuable because it measures plaque. If you see a mole that is changing in shape or color, it’s good to get it checked. There are a few other screening tests that are of value, most routine lab tests can only steer your doctor wrong. And put you at odds with him/her.
Take the time to read the full New York Times article. You’ll never look at the idea that preventative care is the panacea for all that ails us the same again. Now, if only the candidates could get the message.
Oh no, not again!
But not about the above. Off topic, because this is the only to communicate this to you.
This gem just dropped into my mail box. Significant?
(Requires login):
http://www.theheart.org/viewArticle.do?primaryKey=908435&nl_id=tho09oct08
Reproduced below:
Pfizer to drop development of drugs for hyperlipidemia, atherosclerosis, and heart failure
OCTOBER 2, 2008 | Shelley Wood
New York, NY – Pfizer is getting out of the cholesterol-lowering game to focus on what it perceives to be more lucrative diseases, according to an internal memo obtained by Forbes [1]. And for the most part, the chosen “disease areas” don’t include the heart.
In the memo, Martin Mackay, president of Pfizer Global Research & Development (R&D), informed his staff that the company plans to “exit” the fields of atherosclerosis/hyperlipidemia, heart failure, obesity, and peripheral arterial disease.
Instead, the company, whose cholesterol-lowering drug atorvastatin (Lipitor) is the world’s top-selling drug, says it is turning its attention and R&D dollars to cancer, diabetes, Alzheimer’s, pain remedies, and mental health as its “higher-priority areas.”
The news comes in the wake of the flop of Pfizer’s hoped-for new flagship, torcetrapib, a CETP inhibitor that was widely predicted to be the company’s next blockbuster drug. While CV drugs have been the major moneymakers for Pfizer in recent years, those days are drawing to a close. In addition to Lipitor, which will lose patent protection in 2011, Pfizer’s other major player in the CV drug arena is Norvasc (amlodipine), which came off patent in 2007.
Among the lower-priority “disease areas” where the company says it will continue working are thrombosis and transplant, the memo notes.
Contacted by heartwire, a handful of leaders for some of the major Pfizer-sponsored trials in cardiovascular disease over the past decade declined to comment on the company’s announcement or speculate on what it might mean to the field of CV drug development—with one exception. Dr John Kastelein (Academic Medical Center, Amsterdam, the Netherlands), who was an investigator in the Pfizer-sponsored ASAP, TNT, and IDEAL trials, called Pfizer “a real powerhouse” in the CV drug arena.
“I kind of knew this was coming, but when you see it in print, it still hits hard,” he told heartwire. “I think this is very, very significant both for the company itself and for the whole field of CV drug development. Pfizer had truly excellent people in the development arm of their company for CV and metabolic drugs, and they’ve contributed to this whole notion that you need more robust LDL lowering and that that’s better than mild LDL lowering, which has become one of the axioms of CV prevention. And if they’re stepping out now, that not only signifies their own problems, but it also signifies the problems in CV drug development, and how incredibly difficult and costly it has become to bring new drugs forward. And that’s not good for patients.”
Kastelein predicts that drug companies, having “lost faith” somewhat in HDL-raising therapies, will need to look more closely at anti-inflammatory drugs in the setting of coronary artery disease. “But there, the problem is, if you have no biomarkers whatsoever to do even dose-finding studies, you need to move from relatively small phase 2 trials to incredibly large, hard-outcome studies, which is taking quite a risk,” he said. And that, at least for Pfizer, is too much risk.
“Everyone, not just Pfizer, is realizing that the days of the really big blockbuster drugs are over. And what is going to replace that are drugs in a class that are 10 times or 100 times more difficult to develop, so the risks are much higher. And these days, after Avandia and ezetimibe, everything is about safety. This means the FDA is forced, by public and colleague pressure, to demand even larger databases before drugs are going to market, which is of course making it more expensive. It’s a cycle that’s very hard to break.”
Calls to Pfizer were not returned before this story was published.
Source
Herper M. The Pfizer memo. Forbes, September 30, 2008. Available at: http://www.forbes.com/business/2008/09/30/pfizer-drug-agenda-biz-bizhealth-cx_mh_0930pfizermemo.html.
My comment: they made their hay while the sun shone. Now it’s time for them to move on and no doubt they know more about the adverse effects of Lipitor et al than we know and the excretum is about to hit the fan.
All the Best,
Michael Richards
They may well see the wring on the wall. But although they may be abandoning research into new CV drugs, they’re certainly not backing off the promotion of their workhorse Lipitor. Full page ads in all the major papers and TV ads out the yang.
What I found interesting in this article is the following quote:
Being able to modulate a biomarker – LDL-cholesterol – is what has made the statins so successful. Not for patients, mind you, but for the drug companies. First you persuade everyone that a lab measurement correlates with disease, then you get everyone to focus on that lab measurement. Then you come up with a drug that changes the lab measurement by a large amount. Finally, you make billions of dollars selling the drug to people who are worried about their lab values. That’s why biomarkers are so important. If the statin folks had had to demonstrate that statins reduced actual disease, they would have been in trouble. But it was easy for them to show that statins altered a biomarker. And who cares if the biomarker is really a biomarker of disease?
Dr. Eades, do you have a way of us submitting an interesting article to you?
Sure. Just link to it and send it through the comments. People do it all the time.
Two questions you might have covered before:
1) Do you think we are missing out on any vital nutrients by eating only (or mostly) muscle meats and not more brains, organs and bone marrow like our ancestors probably did? If so, can supplementation rectify this issue?
2) What supplements do you currently take and why? (I know you have mentioned Vitamin D and CoQ10 and krill oil in the past.)
Thanks.
P.S. In order to suck up properly and earn a reply to my rather brusque questions, I have just preordered a copy of your new book.
You have to neither suck up nor preorder the new book to earn a reply, but I’m glad you did. Would it be too much to hope that you actually placed your preorder through this site? If so, I’ll make an extra 25 cents or so.
1) Probably not, especially if you throw in a little liver from time to time as I do. And if you’re worried, supplementation can indeed rectify the issue.
2) I take one of our Dr. Eades daily vitamin packs daily. I add magnesium (about 300 mg) and vitamin D (5,000 IU) to that. I throw in a CoQ10 and alpha lipoic acid from time to time (there is some in the vitamin pack I take, but I add extra every now and then). I take krill oil, curcumin, and fish oil daily so that I don’t ever use Advil or other NSAIDS. And I throw in some extra vitamin E to stabilize the fish oil. That’s about it, although occasionally I’ll throw this or that supplement back just for the hell of it. But on no regular schedule. I’ll look in my supplement cabinet and see selenium, so I’ll take one once in a while. Or I’ll see a bottle of resveratrol that I got as a sample at some convention, and I’ll throw one back. Stuff like that. It keeps my body off balance, wondering what’s going to come next.
I’m responding to Kathy of Maine’s comment that the recommendation to lower the upper “normal” limit for TSH levels makes millions of women officially in the hypothyroid category and forced to take expensive medication.
I say, “it’s about time!”. Unfortunately, not enough labs have adjusted their reference ranges yet, so millions of women are still uffering from a variety of hypothyroid symptoms, like infertility, cold intolerance, low resistance to infection, extreme fatigue, sleep disturbances, memory and concentration problems, and more. But they often being told their TSH isn’t abnormal, so it must be something else, or isn’t bad enough to treat. Worse yet, they are considered hypochondriacs, referred to psychiatrists, prescribed a multitude of other drugs to suppress symptoms, instead of addressing the root cause, mild low thyroid function. Thyroid hormone is the master hormone. If it isn’t at an optimal level, none of the cells through out the body work at an optimal level.
I’m one of those age 40+ (premenopausal) women who had a gradually increasing TSH for more than 13 years (also increasing total cholesterol, with the same graph curve as TSH), but my TSH still in the upper half of the “old” reference range (considered normal). TSH tests were run many, many times (during regular exams, two infertility investigations, and exams when I had problematic symptoms), but always in the reference range, so it was ruled out. No one ever looked at the labs over the years to see the slow upward trend. I didn’t realize it until two years ago, but I also had had multiple symptoms of hypothyroidism the entire time and they increased in severity over time – very low body temp, infertility, constant fatigue, sleep disturbances and sleep apnea (despite not being obese and sleeping on my side with my mouth closed), memory and concentration problems, and more. Many of the most bothersome symptoms had prompted numerous doctor visits, with several Rx written, to manage symptoms, and eventually I was advised to get used to getting old and being a tired mother – everyone was (I was 44yo and knew plenty of other mothers who could run rings around me). Even when I mentioned my suspicions about hypothyroidism to my doctor, she said the TSH ruled it out and I should try some antidepressant samples to see if they would help. I looked that medication up and the potential side effects looked as bad or worse than what I was experiencing, plus I didn’t feel they were more than a band-aid solution.
I did some research, went to a new doctor out of network who specializes in hypothyroidism and he prescribed a moderate dose of T4 (very inexpensive, BTW) and compounded timed release natural thyroid extract (not cheap, but a bargain IMO) to provide a small amount of T3 (less than the non-physiological % in Armour thyroid). Before long, I felt quite a bit better, most of the physical symptoms resolved, and I finally had a normal body temperature and was no longer wearing wool socks and sweaters during warm So California summers. My husband noticed I no longer woke abruptly with violent coughing fits (apnea) and my son noticed I could read aloud without yawning (that had been a joke since he was a baby – I couldn’t stop yawning when reading aloud,. but not when talking). I got more housework done, and bit by bit, began to dig myself out of the hole I had sunk into.
Now 2.5 years later, with some minor seasonal adjustments to my thyroid dose, I am nearly myself again. Yes, I have to take a daily medication, but I do it gladly, because I know it is simply a supplement for something my body just can’t make enough of. Most truly euthyroid (healthy thyroid function) people have a rather low TSH, between 1.0-2.0 – higher than that really is suspicious for low thyroid function, even if still in the reference range (like Dr. Eades’ says about the difference between normal and healthy) especially if TSH raises over time.
I’ve read about the idea that hypothyroidism is connected to LC diets in some cases, but I doubt my LC diet, started almost 5 years ago, caused the thyroid problem, because there were symptoms and increasing TSH results that predate the diet change. Though the LC diet may have unmasked the hypothyroidism. Perhaps the adjustment to burning fatty acids for energy instead of glucose all the time is much more difficult when the thyroid function is low or T4 to T3 conversion isn’t adequate. Environmental factors are sometimes considered (fluoride, mercury, PERC in water supplies, etc.) as well as autoimmune issues. I don’t know what caused my my thyroid to peter out, but I do know that the out-dated reference range prolonged a lot of misery and anguish for myself and my family, not to mention perhaps prevented us from being able to have more children (we only have one, despite 7 years of trying).
So I am one who is glad to see the upper TSH reference range finally adjusted downward in more labs, because most doctors these days look primarily at the lab values (if it isn’t flagged you’re fine) and ignore the patient and their history (similar to Dr. Eades’ healthy friend who was prescribed Lipitor and unnecessarily worried). Hypothyroidism isn’t something one wants, believe me, but letting it go untreated or mistreated isn’t a good idea, either.
Hi Anna–
Good to hear from you. You have an interesting, but, unfortunately, all too common history. I’ve noticed over the years that people in the upper range of what was reported as normal TSH often had many of the symptoms you describe. And I wasn’t shy about treating these symptoms. Just like getting reproductive hormones stabilized, treating thyroid dysfunction is required to help people lose weight successfully and keep it off, even though that wasn’t really a problem for you. Had you come to me as a patient, given your symptoms and your high-normal TSH, I would have probably done an iodine challenge test first. If that had been abnormal, which it almost always is because the vast majority of people don’t get enough iodine, I would have started you on iodine supplements first just to see what happened, then fiddled with thyroid replacement a little later. I’m glad you’re doing so well, but it might still be worth it to add a little iodine.
Cheers–
MRE
Um, I forgot one point about the changes in TSH reference range limits. No one is forced to take meds based simply on one lab value; if they feel that way they either need to reconsider their choice of doctor or their understanding of what info the lab provides and what it doesn’t. Yes, that could even mean more tests. It’s a judgement call, and all the judgement isn’t on the doctor’s shoulders.
If one has a TSH lab test value that suggests hypothyroidism, but the patient feels fine, with plenty of energy and able to function fully, then he/she doesn’t have to take or do anything, even if the doc recommends it. I know some people in that situation. There may be some other things going on, such as a pituitary issue that doesn’t accurately provide feedback function (Thyroid Stimulating Hormone (TSH) is made by the pituitary gland to prod the thyroid gland into production). So, no matter what the lab ref range, no one is forced to take meds if they don’t want to or they don’t think they need to.
The problem is a lab range and a doctor that arbitrarily rules out treatment for patients who have a lab using the old range, but are suffering from symptoms (I do understand that many hypothyroid symptoms overlap with other situations, such as menopause, etc.). If the TSH and other thyroid tests look less than really euthryroid, a couple of month’s trial on thyroid hormone will safely determine if that will help or not (though it often takes more than a couple months of “tinkering” to get a good dose level sorted out for optimum results – or even addition of some T3 for residual symptoms, especially memory and concentration issues).
And if the vast majority of normal (euthyroid) people have a TSH value of around 1-2 and medical protocol insists on only treating those inside the “reference range” of .03-5.5 (based on a number of symptom-free test subjects minus the highest and lowest 2.5% values), then that is like fitting a size 10 shoe (normal) on a person with a size 6 (normal) foot and expecting everything to be honky-dory. It’s not. Limiting the upper limit of the reference range to 2.5 or 3.0 (AACE and NACL differ a bit on this) gets the range to more truly reflect normal thyroid function.
Thanks for the followup comment, Dr. Eades. I’ve stayed current with your blog, but I do try to resist commenting so much (except this time!) because I know you can’t help but comment in return
.
I didn’t have the iodine challenge test, but I certainly would have been open to it. I did try manage things nutritionally first, but with no improvement (the best I could figure how on my own, but I was reluctant to follow the supplement dept clerk’s DIY recommendation to load up on iodine).
As I’ve probably mentioned before, most of my family’s food I now prepare from scratch with many very old-fashioned recipes and I source a lot of the produce locally and most of our meat, dairy, and eggs are pastured and directly sourced, too. Good food for myself and my family is a priority, even if that is the only significant thing I get done in a day. And it isn’t as hard as most people think it is.
I do make broth with kombu (seaweed) regularly, use unrefined sea salt (but not iodine-enriched), and sprinkle kelp granules on my morning eggs and other foods. Not sure if that is enough iodine though. I’ve just found a new primary care doc (family medicine) within my network who seemed to demonstrate a nice blend of conventional and holistic views during my short “get-acquainted” appt last month (works with bioidentical hormones and compounded Rx – yeah!), so I’ll ask him about my iodine levels next appt (the highly recommended PCP I saw for just a short time last year was let go from the network for being too much of a square peg in a round hole, which of course, is why I liked him).
My total cholesterol did not go down after starting thyroid treatment (my triglycerides were already low from LC diet), but the HDL went up significantly and my total/HDL ratio “improved” even more. Being a lipid hypothesis skeptic for at least 5 years now, I don’t pay much attention to such tests anymore, but my endocrinologist does focus on those labs and I have to reassure him that I’m familiar with the issues and my numbers don’t concern me (unless cholesterol was too low). I pay more attention to my glucose and HbA1c tests and the direction in which they are heading (IGT).
Dr. William Davis, of the Heart Scan blog, has mentioned several times mild hypothyroidism as a risk factor for CAD in his posts. Just today, he posted another one, specifically regarding the updated TSH reference range and his patients: http://heartscanblog.blogspot.com/2008/10/thyroid-perspective-update.html
BTW, I think Dr. Davis may be backing away from as much use of statins and fear of naturally saturated fats.
Hope you’re right on Dr. Davis backing away from statins and sat fats.
Iodine deficiency is rampant in this country, and probably worldwide. MD and I follow a pretty good low-carb diet, much like the one you describe as preparing for your family. When we took the iodine challenge test, we were both deficient. We starting taking iodine supplements. For what it’s worth, I couldn’t tell a lot of difference, but MD felt a lot better.
“Despite many of the people showing benefit, many dropped out of the study because they missed carbs and sweets. Apparently eating carbs was more important than survival.”
As a former carboholic who kicked my carb habit as soon as I found out I have T2 diabetes I find the lack of a survival instinct in people who are in what I call a ‘death spiral’, puzzling. Diabetics are in a virtual minefield when it comes to risks on every side of serious complications and even early death. The Canadian Medical Association recently published a study that found that diabetics with some form of CHD have a life expectancy of 18 years less than non-diabetics. Other studies have shown that diabetics live anywhere from 12-14 years less than non-diabetics. According to my math this means diabetics can expect to live to around 65 years of age. Not great for one’s retirement years. This should be more than enough to motivate diabetics to break their carb addiction. But apparently not.
Three years ago I had significant loss of tactile sensation in my feet. The feeling has now almost all returned after adopting a low carb diet. Yet when I told diabetic I met recently who has lost most of the feeling in both his feet and is starting to get infections about my results he told me there is no way he is ever going to give up carbs, not for anything.
Even more amazing was a study I came across recently that found that some teenagers with insulin dependent T1 diabetes are stopping their insulin injections for a period of time and eating pizza, burgers and fries with their non-diabetic friends so they “can be normal”. Scary!
It beggars belief. See today’s post for even worse examples.
Quote from ‘Diagnosis Greed’ (article today in New York Times Online)
Scientists in government agencies aren’t above suspicion, either: Angell cites a study of 200 government panels that issued practice guidelines, which found that more than a third of the authors had some financial interest in drugs they recommended. And “perhaps most importantly,” she writes, many members of 16 standing committees that advise the Food and Drug Administration on drug approvals also have financial ties to drug companies. “Although these individuals are supposed to recuse themselves from participating in decisions about drugs made by specific companies with which they have a financial relationship, that requirement is frequently waived by F.D.A. authorities,” Angell writes.
OK, so maybe picking on hypothyroid was a bad example.
Maybe I’m just jealous because I keep getting high TSH readings (4.89 at my last test in February) and yet can’t get anyone to treat me for it.
I was given a take-home iodine test, but never did it because I read that iodine deficiency is extremely rare these days since they started putting iodine in salt. Granted, I eat VERY little salt, but still. Gee, maybe I should pursue this again.
Dr. Eades, would you PLEASE go back into private practice? I swear I’d travel from Maine to California if you’d agree to take me on as a patient!
Actually, iodine deficiency is very common. And even increasing consumption of salt won’t help much because the kind of iodine found there isn’t all that absorbable.
If the economy keeps going the way it’s going, you may get your wish about our going back into practice.
Cheers–
MRE
res glucose tolerance tests. I often wonder why doctors don’t simply alternate fasting blood glucose tests with tests two hours after a carby breakfast or lunch. For a pregnant mother it could be by the month, for annual physicals it could be done by the year. And further, why send it off to a lab, unless a problem shows up. Just use a good brand meter in the office. Home blood meters are typically within 5% accuracy which is enough. People can see, preferable do it themselves, how to test blood. Us diabetics are often asked to test friends and relatives blood. The only downside is that if someone is high their chances of their doctor doing anything useful is close to zero.
ps – and when we test someone else, it needs to be always lancet.
also re: glucose tolerance tests–why don’t doctors simply check A1c? Since that’s a sure-fire indicator of a person’s average blood glucose over time, and since it’s relatively cheap and easy.
“Actually, iodine deficiency is very common. And even increasing consumption of salt won’t help much because the kind of iodine found there isn’t all that absorbable.”
Some medical researchers are making a very good case for widespread iodine deficiency and are recommending a daily supplement in the order of 10 or more milligrams. But I have had a hard time finding an absorbable, high potency iodine supplement. The only one I have found so far is called Iodoral. Do you know of a good iodine supplement?
Iodoral is a good supplement. It’s the one we use. There are a couple of companies that have sent me info on new iodine supplements they’re making, but I haven’t used the products yet. I’ll probably do a post on the whole iodine deficiency issue after I’ve done a little more product evaluation.
Re: Iodine.
How much should one aim for in a day? I came across some kelp capsules.
Iodoral is a pretty good supplement that’s well absorbed. You can find it online. Kelp capsules contain some iodine, but not as much, I don’t think, as Iodoral.
Dr Donald W. Miller, Jr, MD – Professor of Surgery at the University of Washington in Seattle (www.donaldmiller.com) has written a number of articles on iodine deficiency and supplementation. Miller claims that, taken in greater doses than the recommended dietary allowance, iodine has a record of success in reversing fibrocystic breast disease and preventing breast cancer. Miller claims the average iodine intake of Americans is 240 micrograms per day whereas the Japanese consume an average of more than 12 milligrams per day.
Former professor of obstetrics gynaecology at UCLA, Dr. Guy Abraham, started a study in 1997 called The Iodine Project based on the hypothesis that maintaining whole body sufficiency of iodine requires 12.5 mg per day. According to Abraham whole body sufficiency exists when a person given a 50 mg load of iodine excretes 90% of the iodine load. The iodine project has found that iodine reverses fibcrocystic disease, diabetic patients require less insulin, hypothyroid patients require less thyroid medication, symptoms of fibromyalgia subside and patients with migraines stop having them.
In the area where I live there appears to be a cluster fibromyalgia. I have spoken with some of the patients. They told me that their symptoms come and go and are often debilitating. Drugs prescribed by their MDs do not help. Since the treatment of this group is managed by a regional chronic illness coordinator for our health care system I passed along one of Miller’s articles on iodine and fibromylagia to her. She dismissed out of hand any possible role of iodine in fibromyalgia by stating that iodine deficiency does not exist in North America because “iodine is added to salt”. Despite the fact that the iodine in salt is not readily absorbed, she and other health care professionals are pushing for a reduction in salt intake which would also reduce the intake of iodine. Perhaps this concept was exceedingly difficult for her to grasp. She went on to state that diseases like fibromyalgia are “far too complicated to be treated with simple things like iodine” (read: fibromyalgia needs lots of pharmaceuticals).
Insofar as your invitation to bash our socialized health care in Canada I would be more than happy to oblige. However, if I really get started it would take a blog of its own. So I will limit my comments to one of my biggest gripes; a set fee per consult.
Social medicine is a numbers game for MDs working the system. MDs get a fixed fee which is not based on results (which don’t matter a whit so long as MDs follow established treatment protocols), but on consults. I don’t care how altruistic or humanitarian an MD is when he or she first starts to practice if they can do basic maths it is only a matter of time before they make the connection that the more patients they run through their practice, the more money they make. It is dead simple. And the fastest way to run patients through is to write a script every 4 or 5 minutes. Some MDs excel at speed writing.
Patients are usually happy because they think scripts represent good treatment. They are also happy because they believe our social health care system is free and they are entitled to free treatment for anything that ails them right up until time they die. If health care costs keep rising at the current rate, Canadians are in for a very nasty surprise. My health care plan says that I have a maximum life time limit of $100,000 after which I pay everything myself. And I have a premium plan with all the bells and whistles. If I get hit with a big one like a transplant and post operative treatment I think $100 K would not go very far.
Thanks for the excuse I need to eat more sushi. Currently I’ve been eating it once a week, maybe that’s not enough. Maybe my problem is that I order mostly sashimi, since maki generally has rice in it. I get one maki order with minimal rice (either uni or ikura), and a spider roll which the chef at my usual place makes without rice for me, and the rest is sashimi. So not a lot of seaweed there. Guess I’ll have to go more often.
My doc has religion – in his mind the ONLY acceptable values for total cholesterol are between 0 and 199. So, we are at odds, as my last check showed 207, and he really wants me on statins. Even if you thought these drugs worked, it seems to require at least a lack of perspective to justify the expense and the side-effects for what looks like margin of error on a lab test. Whatever, not for me.
However, my question relates to our 17 year-old son who may have just the opposite situation – a real problem that isn’t widely recognized as such. After donating blood, he received a total cholesterol reading back from the blood bank – just 114 (no breakdown). Step 1 is to have the result checked. If we confirm that he’s this low, what additional steps do you recommend? Do you know of anyone in the Dallas medical community who would have a healthy perspective on this?
Thanks for your books and good work
I wouldn’t worry about it as long as everything else is okay. Adolescents and young adults often have cholesterol levels in this range. I remember when I was in medical school and we all got our labs checked. Almost everyone had cholesterol levels in the very low range.
Is their a conflict with one’s 1] limiting intake of alpha linolenic acid and 2] taking fish oil capsules (or the alternative cod liver oil capsules)?
Not as far as I’m concerned.
I have been on the PP diet since the start of the year and have lost about 35 pound. I am stuck at about 205, so I going to try “Boot Camp” from your maintenance book. I started with a new doctor at the end of September. He wanted to know why I had stopped my statin. I explained my memory problems. I have an appointment in December to check my blood values. He did recommend a calcium scan. Since you encouraged this too, I did it this week. I expected a low score due to low carbing, but I blew the top off 3483. (The cost was $250) The nurse who gave me the results seemed to think that I was a walking time bomb. I am sure that the doctor will want to start me on statins again in December. I am 68 and no symptoms. My BP was 140/85 in September in the doctor’s office with my current medications. So now I have this information and don’t know how to use it. I plan to keep on the pp diet, keep up my exercise (45 minutes three times a week on the treadmill). I am listing my supplements, do you have any suggestions?
Morning (with Tomato Juice)
Triam/Hctz 37.5/25
Lisinopril 10 mg.
CoQ10 100mg.
TwinLab Krill Oil 500mg
Alpha Lipoic Acid 100 mg
Dinner
Fish Oil 1200 mg
Turmeric Curcumin 450/50 mg
Acetyl L-Carnitine 250 mg
Vitamin D3 1000 mg
Spectravite Senior alternate with Vision Formula
Evening
Magnesium Oxide 250 mg.
Enteric Aspirin 325 mg.
Xalatan 0.005% Solution (both eyes)
Feel free to edit this long post.
If I were you I wouldn’t wait until December to go back to the cardiologist – I would try to go ASAP. There is some indication that statins do reduce calcium scores, but at what cost? The studies on all-cause mortality for men over 65 show no difference whether on a statin or not, which means that any improvement in heart disease risk if offset by an increase in other risk factors. The studies of the Masai by George Mann showed that these tribesmen who ate a high-meat, high-dairy low-carb diet had fairly significant coronary arterial plaque but no actual heart disease. Their plaque was stable. Stable plaque isn’t all that risky – it’s the unstable plaque that is problematic. It would be nice to have known what your calcium score was a year or two ago. No change between then and now would indicate stable plaque.
You should spend some time on Dr. Davis blog (see particularly his recent post on Scare Tactics before you see your cardiologist) and join his Track your plaque program. He has had great experience with increasing vitamin D intake in his patients with high calcium scores, so read about that. The 1000 IU your taking falls far short of his recommendation.
Keep me posted
I took statins for 11 years, finally woke up to the fact that they made me feel awful (depressed and in pain). Quit, and then looked for something better.
Coronary calcium scoring is a much better way to go. Several points here. You are unlikely to find an EBT machine to do this in New England. New 64 slice CT machines can do the job just fine, with low radiation if prospective gating is used. I paid $150 out of my own pocket for it. (One lab wanted $3,501 for the same procedure – shop around or go to the Track Your Plaque website for help finding one.) I am in the 80th % ile for my age, not good but not devastating.
I can work my problem for a lot less than the annual cost of my Lipitor. I can measure success with a coronary calcium scan every couple of years. Not cheap, but a great investment in longevity. Plus, I feel so much better, stronger, more athletic, better in the sack, etc. since pitching the Lipitor and correcting some nutritional problems, it is amazing.
Glad to hear you’re doing so well.
I still want universal health coverage. They have it in the military, and it’s worked out fine. No, I’m not talking about the VA. I was a brat, then a soldier, then an Army wife in the first 25 years of my life, thus a beneficiary of the only single-payer system in the United States. Did you know it takes up less than one-fifth of the Department of Defense budget as of 2007? That’s including all the spouses, kids, and elderly that are also cared for in the system, and by 2007 they were seeing IED survivors from Iraq and Afghanistan as well.
What I want is for the middlemen to be cut out, the government to be footing the bill and for us to have a lot more choice in what treatments we choose and for what. But it’s no different than having a military or police or firefighters, and we all pay for those, and they still help people too poor to pay taxes. Illness and injury kill more people than war does. Time to look at medicine as a form of national defense.
It’s not enough to have private insurance. People lose their jobs when they become too sick to work, then they lose their insurance and then they have pre-existing conditions that won’t be covered for too long a time, if ever. Or the only treatment available is “experimental,” so isn’t covered. Or the patient uses up their lifetime maximum on the policy.
Cutting out insurance isn’t going to help. I once thought as you probably do, that insurance has driven up the cost of care and that we could all afford a doctor when we could pay him cash. Before insurance was invented, medicine was a lot more basic and crude than it is now. And even then there were too many people who couldn’t afford the doctor, which is why insurance was created to begin with. There was already a market for it because people were already getting in over their heads.
This is just one of those issues on which we’re going to have to bite the bullet and distribute the risk. And I hate to say it, too, because I know the government is capable of overstepping its bounds and often willing to do so to boot. But I hate the idea of people dying unnecessarily even more.