SMOKING, DRINKING, AND THE NEW PLAYER: MARIJUANA!

marijuana

We medical practitioners have long been preaching about the dangers of both smoking (tobacco) and drinking in excess (alcohol). But nowhere has the old adage “familiarity breeds contempt” been more appropriate than in connection with these two vices. We seem to ignore the fact that tobacco smoke accounts for at least 450,000 deaths yearly in this country alone. And although the numbers are not as clear in regard to excessive alcohol consumption, we do know that alcohol accounts for numerous deaths yearly, both acutely or chronically. As we leisurely sip our martinis at cocktail parties, we pay little heed to this danger, finding it reassuring that—in contrast to many confirmed alcoholics—we are able to confine our intake to safe quantities at less frequent intervals.

And now we are being confronted by a new challenge: Marijuana! This substance is moving to center stage because of its legalization in such states as Colorado and because of political pressure on the federal government to avoid conflict with the states and stop incarcerating users and sellers of marijuana.

Unfortunately, until now, far too little research has been done on this substance—either for medical uses as well as for recreational purposes. But one thing is quite clear: Marijuana will never account for as many deaths as do both tobacco and alcohol.

For a clear-headed discussion of the subject of marijuana, I refer you to a recent article written by Sheila Kennedy, my cousin, who normally comments accurately on many important topics of public and political concern. http://www.sheilakennedy.net/2016/08/smoking-and-drinking/

In this article, she makes an eloquent case for legalization, or at least decriminalization, of marijuana. It’s well worth reading!

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Meal Replacement Products

diet alts

      Meal Replacement & Weight Management Powders and Beverages

      These days we are encountering an increasing number of nutritional supplements in a bottle. There are many different reasons for using such a product, which can be in a “ready-to-drink” form, or which you make from a powder. For example, you may not have time for a meal but want something more healthful rather than a snack food. Or you may be on a diet and it’s easier for you to use a single product with the right balance of nutrients and calories than having to select the right foods yourself. Or maybe you want to boost your protein intake with the convenience of a meal replacement rather than a strict protein product.

The United States Department of Agriculture (USDA) recommends that most adults who perform light to moderate activity get roughly 2,000 to 3,000 calories per day from a varied diet in which approximately 60% or fewer calories come from carbohydrates, at least 10% come from protein (meat and vegetable proteins), and about 30% come from fats — with less than 10% of calories coming specifically from saturated fat. Healthcare professionals tend to suggest a somewhat higher percentage of calories from protein (15% to 20%) and a lower percentage from carbohydrates, although recommendations vary. Nutrition powders and drinks can help provide some of these nutrients but they are not recommended as a total substitute for food, as they lack some of the vitamins, minerals, fibers, and phytonutrients found in whole foods.

Meal replacement powders typically come in canisters or packets ready to be mixed with water, milk, juice, or other beverage. Meal replacement drinks often come in ready-to-drink cans or bottles. These products are marketed as dieting aids and meal replacements. Unlike, protein powders, they generally provide a more balanced ratio of protein, carbohydrates, and fats, as one might get from a healthful meal.

Unlike nutrition bars, which need to contain a good amount of carbohydrates to give them a reasonable texture, feel and taste, meal replacement powders and shakes do not. Consequently, makers of these powders and shakes can offer more flexibility in the nutritional content of these products. For example, it is quite possible to find powders and shakes with half the fat and carbohydrates of most nutrition bars, while often offering twice the protein.

   Advantages: They have been shown to help people on diets lose more weight, improve blood sugar control for people with type 2 diabetes, and boost protein intake to increase muscle mass. They can also offer a more healthful alternative to snack foods when you are unable to have a regular meal. In particular, meal replacements offer protein in a convenient form, along with carbohydrates (and often fiber) as well as fats. The products, however, are not meant to replace all of your meals and consumption of whole foods, such as fruits and vegetables. Although quite variable, most products provide about 10 to 20 grams of protein per serving but vary in the amounts and types of carbohydrates and fats they include. They may also contain a range of vitamins, and minerals.. Serving sizes also range widely, from about 25 to 60 grams providing from 90 to 400 calories.

One important caution must be given for all such products: Do not substitute any of them for all of your meals or be fooled into thinking that you can skip eating whole foods.

Depending upon the needs of each individual, it’s impossible to suggest the best choices, but we can list some good picks based upon accuracy of labeling and features such as protein, energy, fiber and cost.

           Meal Replacements for Weight Loss:
A review of six randomized, controlled clinical studies comparing the effects of partial meal replacement plans (consisting of a reduced calorie diet providing between 800 and 1600 calories daily in which one to two meals per day were replaced with a liquid, vitamin and mineral fortified meal replacement product) with conventional, reduced-calorie diets found that after three months, those who used a meal replacement product lost an average of about six pounds more than those who followed a reduced-calorie diet without meal replacement (approximately 13 1/2 lbs. versus 71/2 lbs., respectively)    Among the four studies which continued for another 9 months, people who consumed meal replacement products had a total average weight loss of about 15 lbs. by the end of one year, while those who maintained a reduced-calorie diet without meal replacements had a total average weight loss of about six lbs. One word of caution:  It should be noted that the authors of the review were each associated with either Slim Fast or the “Slim Fast Nutrition Institute,” and that most of the studies in the review appeared to use SlimFast products and/or were funded by Slim Fast

Increasing Muscle Mass and Strength:
Protein is necessary to build, maintain, and repair muscle. Meal replacement products which are high in protein can help you boost your protein intake. Be aware, however, that while getting more protein can help you increase muscle mass, it won’t increase strength unless used as part of appropriate exercise program.

Quality Concerns:
Neither the U.S. Food and Drug Administration (FDA), nor any other federal or state agency, routinely tests meal replacement powders and drinks for quality.. One independent source found that among the 11 meal replacement powders and drinks selected and tested, only 7 met quality standards and were approved based on their quality and labeling.

Which product to consider: The product you choose depends very much on your purpose for it. However, when looking for a meal replacement, I would look for one with a reasonable balance of protein, carbs, and fat, some fiber, some vitamins and minerals, and, hopefully, a reasonable cost. With that in mind, the following are top picks among the products in this review which passed tests for quality:

For General Use:  Special K Protein has a good balance of nutrients, including fiber, provides a good amount of energy (180 calories), and is reasonably priced ($1.90 for a 10 fl. oz. bottle). However, the majority of its 28 grams of carbohydrates is from sugar (18 grams), which is a bit high, and some flavors may contain caffeine. Caffeine is absent in flavors such as Red Berry, Chocolate Delight, or French Vanilla.
Special K Protein is comparable to the very popular Ensure Original, which provides about the same amount of protein and fat. Ensure provides more carbs (40 vs. 28) and, consequently, more Calories (220 vs. 180), but, like Special K Protein, most of the carbs in Ensure is sugar (23 grams). Both products provide an array of vitamins and minerals. Ensure Original, however, provides no fiber, while Special K Protein provides 5 grams.

For extra protein:  IsAgenix IsaLean Shake Natural — Berry Harvest. This product provides more protein than most others . It also provides fiber, is low in sugar, and offers 250 calories. It’s more expensive than most products ($3.62 per 61 gram packet) but serving sizes are larger.

For dieting: There is likely no “magic” meal replacement formula for losing weight from a diet. What seems to be most important is that the dieter is able to stick with a reduced calorie diet over a sufficient period of time. A reduced-calorie meal which is convenient and satisfies the senses and hunger is what is needed. Having some fat in the meal helps with this (as well as being nutritionally important), and fiber may also help, as it slows digestion. Two lower-calorie products which seem to fit this bill are Atkins Day Break Strawberry Banana and SlimFast Advanced Nutrition — Creamy Chocolate. They are both come in 11 fl. oz. ready-to-drink containers and are relatively inexpensive: Atkins costs $1.50 and SlimFast costs 16 cents more — but provides twice the protein.

Conclusion: Depending on your needs, one of these products may be worth considering. If for nothing else, they could be used to replace the empty calories contained in most snack, or “junk” foods.

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CUPPING, ANOTHER FORM OF “WOO”

Cupping     

Woo (sometimes called Woo Woo) refers to ideas considered irrational or based on extremely flimsy evidence or that appeal to mysterious occult forces or powers.

According to the standard dictionary, this term is applied to emotions, mysticism, or spiritualism, outside of the bounds of science. It can also represent a person who harbors mystical beliefs. Medical science also recognizes woo as a synonym for pseudoscience or quackery. Basically it boils down to pure nonsense or irrationality.

   Now let’s apply Woo to a real contemporary situation: Did you notice several round red circles on the torso of Michael Phelps, the all time greatest swimmer?  These blemishes resulted from a practice known as “cupping therapy”, which is an ancient form of treatment in which a local suction is created on the skin, which is provided by suction created with heat (fire) or mechanical devices (hand or electrical pumps). Practitioners believe this mobilizes blood flow in order to promote healing. All the critics of alternative medicine, including myself, call cupping “pseudoscience nonsense”, “a celebrity fad”, and “gibberish” Pharmacologist David Colquhoun writes that cupping is “laughable… and utterly implausible”. Despite a total lack of validity, Chinese cupping has gained much publicity due to its usage by famous sport figures including not only Phelps, but also Denver Broncos player DeMarcus Ware, Olympians U.S. gymnast Alexander Naddour, and others. Actually, there is no evidence that cupping works any better than a placebo, i.e. any dummy pill or useless maneuver.

With regard to the placebo effect, however, it can be quite powerful, for past studies have demonstrated that even athletic performance can be enhanced slightly by placebos (dummy treatments), a point that I documented in my book, “Snake Oil is Alive and Well”. This effect supports the idea that the mind can be a powerful influence on not only the sensation of pain, but even physical performance! The placebo effect is ubiquitous and can explain identical “cure” rates stemming from other nonsensical forms of “treatment” such as magnetic therapy, reflexology, acupuncture, faith healing and many others. Placebo effects are most powerful when there is physical contact (laying on of hands) by the practitioner, supported by expectations of success, usually combined with elaborate and convoluted rituals and explanations. Aiding this effect is the natural tendency of all maladies to fluctuate or spontaneously resolve; thus any type of intervention that precedes an improvement stands to receive the unearned credit for “success”.

So, when Phelps goes out a winner, could the cupping have accounted for his success? You be the judge!

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The Narcissistic Personality Disorder: Sound Familiar?

As a physician I have receiving training and dealt with various mental disorders, but have been impressed recently by a report shedding more light on the issue of narcissism, which seems to be entering into the political arena. While we now live in a culture that some would call narcissistic, with millions of people constantly taking selfies, spewing out tweets and posting everything they do on YouTube and Facebook, many of us possess some qualities that can be considered narcissistic. Only a few, however, harbor an extreme form, and thus, some would consider this a form of insanity.

So what are these features? The common characteristics of extreme narcissism were described by Joseph Burgo, a clinical psychologist, in his book “The Narcissist You Know”. In it he describes the extreme narcissist as a breed unto themselves. They may be highly successful in their chosen fields but extremely difficult to live with and work with. Their characteristics are the following:

*Highly competitive in virtually all aspects of his life, believing he possesses special qualities and abilities that others lack; portrays himself as a winner and all others as losers.

*Displays a grandiose sense of self, violating social norms, throwing tantrums, even breaking laws with minimal consequences; generally behaves as if entitled to do whatever he wants regardless of how it affects others.

*Shames or humiliates those who disagree with him, and goes on the attack when hurt or frustrated, often exploding with rage.

*Arrogant, vain and haughty and exaggerates his accomplishments; bullies others to get his own way.

*Lies or distorts the truth for personal gain, blames others or makes excuses for his mistakes, ignores or rewrites facts that challenge his self-image, and won’t listen to arguments based on truth.

Of course, nearly all of us possess one or more narcissistic traits without crossing the line of a diagnosable and pathologic disorder. And it is certainly not narcissistic to have a strong sense of self-confidence based on one’s abilities.

“Narcissism exists in many shades and degrees of severity along a continuum,” Dr. Burgo said, and for well-known people he cites as extreme narcissists, he resists making an ad hoc diagnosis of narcissistic personality disorder, as defined by the American Psychiatric Association.

The association’s diagnostic manual lists a number of characteristics that describe narcissistic personality disorder, among them an impaired ability to recognize or identify with the feelings and needs of others, grandiosity and feelings of entitlement, and excessive attempts to attract attention.

Dr. Giancarlo Dimaggio of the Center for Metacognitive Interpersonal Therapy in Rome, wrote in Psychiatric Times that “persons with narcissistic personality disorder are aggressive and boastful, overrate their performance, and blame others for their setbacks.”

According to the Mayo Clinic, people with a narcissistic personality disorder think so highly of themselves that they put themselves on a pedestal and value themselves more than they value others. They may come across as conceited or pretentious. They tend to monopolize conversations, belittle those they consider inferior, insist on having the best of everything and become angry or impatient if they don’t get special treatment.

Underlying their overt behavior, however, may be “secret feelings of insecurity, shame, vulnerability and humiliation,” Mayo experts wrote. To ward off these feelings when criticized, they “may react with rage or contempt and try to belittle the other person.”

Dr. Burgo notes that many “grandiose narcissists are drawn to politics, professional sports, and the entertainment industry because success in these fields allows them ample opportunity to demonstrate their winner status and to elicit admiration from others, confirming their defensive self-image as a superior being.”

The causes of extreme narcissism are not precisely known. Theories include parenting styles that overemphasize a child’s special abilities and criticize his fears and failures, prompting a need to appear perfect and command constant attention.

Although narcissism has not been traced to one kind of family background, Dr. Burgo wrote that “a surprising number of extreme narcissists have experienced some kind of early trauma or loss,” like parental abandonment. The family lives of several famous narcissists he describes, Lance Armstrong among them, are earmarked by “multiple failed marriages, extreme poverty and an atmosphere of physical and emotional violence.”

As a diagnosable personality disorder, narcissism occurs more often in males than females, often developing in the teenage years or early adulthood and becoming more extreme with age. It occurs in an estimated 0.5 percent of the general population, and 6 percent of people who have encounters with the law who have mental or emotional disorders.

As bosses and romantic partners, narcissists can be insufferable, demanding perfection, highly critical and quick to rip apart the strongest of egos. Employee turnover in companies run by narcissists and divorce rates in people married to them are high.

“The best defense for employees who choose to stay is to protect the bosses’ egos and avoid challenging them,” Dr. Burgo said in an interview. His general advice to those running up against extreme narcissists is to “remain sane and reasonable” rather than engaging them in “battles they’ll always win.”

Despite their braggadocio, extreme narcissists are prone to depression, substance abuse and suicide when unable to fulfill their expectations and proclamations of being the best or the brightest.

The disorder can be treated with drugs and psychological counseling, though therapy is neither quick nor easy. It can take an insurmountable life crisis for those with the disorder to seek treatment. “They have to hit rock bottom, having ruined all their important relationships with their destructive behavior,” Dr. Burgo said. “However, this doesn’t happen very often.”

If this disorder is actually a form of insanity—or at least a severe mental disability—one might logically ask whether such an individual should be allowed to run for high public office such as the presidency. You make that call!

Trump2

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DRUG PRICES: WHY ARE THEY SO HIGH AND CAN WE DO ANYTHING ABOUT IT?

drug prices

    America spends a tremendous amount for prescription drugs—$424 billion last year alone. And that number is rising fast with no sign of slowing down anytime soon. We often encounter horror stories of drug companies that decide to raise prices to astronomical levels, and we wonder why they get away with such reprehensible behavior. The answer is, sadly, because they can!

We have long known that when new drugs are patented, the originating company gains the exclusive right to be a de facto monopoly for the life of the patent, ordinarily 17 years. After that, competition is allowed to enter and, in theory, provide generic versions, which should cause the prices to drop considerably. But now we are witnessing a significant increase in both new and some older drugs as well.

Let’s look at some reasons for such high prices:

Reason 1): Drug companies can charge whatever price they want. There is simply no regulatory source, government or otherwise, that has the power to control drug pricing. When asked why they are charging apparently exorbitant prices, they often respond by claiming they are recouping very high costs for research and testing. This is partially true, but, for large companies such as Pfizer, approximately 16% of their revenue is devoted to research, whereas they spend about 30% on selling, marketing, and advertising expenses. Moreover, taxpayers already shoulder a substantial portion of those research costs. About 38% of all basic science research is paid for with tax money through federal and state governments, according to a recent study published in the AMA journal.

There is also no restraint on companies’ raising prices on already marketed drugs that continue under patent protection.  For instance, in the past year or so, Abilify, given for bipolar disorder and other mental problems, increased over 10% to approximately $1,000 per average monthly prescription.

Reason 2): Insurance companies are charging you more. In theory, these companies should be protecting you against high prices, but instead, they have been passing on the elevated prices through raising your co-pay or deductible amounts, or simply raising your premiums, all of which, in effect, pass on much of the high costs directly to the consumers.

Reason 3): Old drugs are being reformulated as costly “new” drugs. One example is that of insulin, a drug that is over 100 years old. But companies repeatedly change its formulation, allowing them to get new patents each time. For instance, one new form of insulin is called Toujeo, given by an injection that lasts for about 1 week. Each dose of 450 units may cost about $350, and depending upon how much one requires, can amount to tidy sums for the company.

Reason 4: Generic drug shortages can trigger massive price increases. For various reasons, shortages of basic ingredients of generic drugs can arise and lead to price gouging. One example is that of the old drug, colchicine, commonly used for the treatment of gout, a form of arthritis. In past years this drug could be purchased for mere pennies, but now, it retails for approximately $8 per pill, and often as many as 8-10 pills or more can be necessary for a single attack. A daily dose of one pill or more may also be needed on an extended basis.

Reason 5): “Specialty” drugs can be “out of sight”. The rise of super-expensive, so-called specialty drugs is a real threat. For example, the hepatitis C medications, Sovaldi and Harvoni, can cost up to $95,000 for a single 12 week course of treatment.

At present, according to a recent report by the Congressional Research Service, these drugs account for less than 1% of prescriptions in the U.S. but represent about one-third of total drug spending by consumers. Since drug companies push heavily in the direction of such highly profitable products, it is likely that by 2020 very expensive drugs will constitute an even bigger chunk of drug spending.

More than half of the 56 medications approved by the FDA in 2015 were of this specialty variety, and more than 900 biologic drugs are currently under development. While these products offer great hope for the future, this raises the important question of how society is going to afford them.

Compounding this problem, competition in this specialty arena may not eventually bring down prices as one would usually expect, for many such drugs are biologics—medications derived from living microorganisms. That makes them much more difficult to copy than conventional drugs, meaning that cheaper generics are far more difficult to produce in a reasonable period of time.

HOW CAN WE DEAL WITH THIS PROBLEM?

The drug companies should be encouraged to adopt a more humane policy, which would involve controlling prices at a more reasonable level, certainly in line with overall inflation. But at least they should be forced by the public to justify apparently unreasonable prices. For instance, Vermont passed a bill that requires these companies to justify high costs and price increases, and to calculate the financial effect on insurance premiums with many specified drugs. This measure at least raises public awareness and provides misbehaving companies with bad PR, something that should get their (and their stockholders’) attention. In most foreign countries, governmental intervention causes prices for the same drugs to be considerably less than in the U.S. For instance, in the U.K., a centralized advisory board calculates the value of a medication by taking into account a drug’s efficacy, safety, and total benefits to the healthcare system. As a result the price of the same drugs in that country averages about 50% less then here. Although reasons vary from country to country, prices in the U.S. are far greater than all the other western nations.

Our government should do more to curb these prices, and could accomplish this through the following means: First they could set a limit on out-of-pocket costs, providing protection against very high or sudden spikes in prices. For instance, California enacted a law limiting a consumer’s burden at $250 for a single prescription drug per month, or $500 for certain high-deductible plans. Second, they could more rapidly approve more generic versions of common drugs, currently a slow process. Third, they could allow limited importation of drugs from legitimate Canadian and European sources, which is currently illegal under U.S. law. Fourth, they could use their so called “march in” rights, that is, in cases of high prices of drugs developed in part from taxpayer money, the Department of Health and Human Services could force the company to allow another manufacturer to make a generic version that is cheaper for the consumer. Finally, the government should prohibit direct to consumer advertising of prescription drugs; other than New Zealand, we are the only nation that allows such promotion.

Perhaps the most potent means to control excessive pricing is through the enactment of a single payer system in the U.S., i.e. Medicare for all, which I have discussed before, http://www.mortontavel.com/2015/12/31/. This would allow the government to negotiate directly from a position of power with all pharmaceutical companies. This provides another good reason—of many—to move to the single payer format. Some have estimated that such an intervention could reduce drug prices by about 40%.

Finally, the consumer can fight back on a personal level. Ask your physician, before he or she writes a prescription, what the expected costs are likely to be, and if there are equivalent cheaper generics available. Although you could mention a given drug advertised on TV, do not insist that you receive it unless this is agreed upon by your own doctor. Also, there are many instances of older drugs, while not identical to the newer patented variety, are just as effective and far less expensive.

In all instances, consider shopping around for the lowest prices, which includes online sources such as GoodRx to learn a drug’s “fair price.” Prescriptions can be filled by legitimate sources such as HealthWarehouse.com. Be careful, however, since fraudulent sites abound, use only those operating within the U.S. and display the VIPPS symbol to show that it’s a Verified Internet Pharmacy Practice Site.

Unfortunately, the ultimate answer may lie with our government, which has to power to restrict such excesses, while, at the same time, must avoid stifling necessary research. This is a daunting task, but for those that believe that government should stay away from this problem altogether, be ready to suffer the consequences!

 

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Aren’t all mass shooters mentally ill?

gun and insanity

Here is what LIZA H. GOLD, MD, clinical professor of psychiatry at Georgetown University and contributing writer to the book “Gun Violence and Mental Illness” American Psychiatric Association Publishing, 2016, had to say in answer to this question..

On June 12, 2016, a man walked into an Orlando, Fla., nightclub and committed the worst mass shooting in U.S. history. When it was over, 49 people lay dead and more than 50 others were wounded. The shooter must have been mentally ill. Only someone with a serious mental illness would commit such a horrible crime, right?

Wrong! Evidence indicating that the perpetrator’s motives lay in his political/religious ideology and possible homophobia quickly knocked mental illness out of the debate about motivation behind this particular shooting. Nevertheless, media speculation about mental illness invariably accompanies mass shootings.

Mass shootings are the most sensational, gut wrenching, and widely publicized form of firearm violence. Nevertheless, statistically speaking, mass shooting homicides are the rarest form of firearm death. These incidents account for less than 1% of firearm mortality each year. About 33,000 people a year are killed by firearms. Firearm suicide accounts for about 65% of these deaths; the rest are overwhelmingly the result of interpersonal violence, not violence committed by a stranger with a gun.

All of us recognize the images of mass shooters who were in fact mentally ill, such as the young man with the dazed look and red hair in Aurora, Colo., and the chilling images of the Virginia Tech shooter posing with his weapons. Individuals in the first throes of psychotic illness are at increased risk of committing some type of violence as their functioning deteriorates, their thoughts become more disordered, and their lack of insight often leads to treatment refusal.

However, most mass shooters are not suffering from serious mental illness. As has been discussed in a recent article, mass shooters often hold “extreme overvalued ideas,” that is, nondelusional, strongly held beliefs, a concept that does not fit neatly into psychiatric diagnostic categories. As Dr. Tahir Rahman, an assistant professor of psychiatry at the University of Missouri, Columbia, and his colleagues wrote in a recent study: “An extreme overvalued belief is one that is shared by others in a person’s cultural, religious, or subcultural group. The belief is often relished, amplified, and defended by the possessor of the belief and should be differentiated from a delusion or obsession. The idea fulminates in the mind of the individual, growing ever more dominant over time, more refined, and more resistant to challenge. The individual has an intense emotional commitment to the belief and may carry out violent behavior in its service. It is usually associated with an abnormal personality.”. We used to refer to people who hold such beliefs as “fanatics.”

The line between psychotic delusions and extreme overvalued ideas is not always clear, but some markers and signposts can differentiate between the two. Psychiatric illness is suggested, for example, by the presence of other recognizable symptoms of mental illness, such as other delusions, hallucinations, or thought disorders. In addition, individuals with psychiatric illness demonstrate related functional impairment preceding and unrelated to the mass shooting. Finally, delusions are rarely shared by even two individuals; they are not shared by large groups.

Examples in which large groups of people share social, religious, or political beliefs and some believers resort to violence can be found throughout history: from Masada to 19th century abolitionists such as John Brown to 20th century animal rights activists and 21st century “sovereign citizens.” Finding groups that reinforce and validate extreme beliefs has become even easier in the age of social media.

However, fanatics often function adequately in society until something happens to trigger a choice to act violently. Absent a history of felonious violence, these individuals are not likely to be barred from owning firearms. More non–evidence based firearm ownership restrictions for those with mental illness are not likely to slow down or decrease the rising rate of mass shootings.

We do not have more people with psychosis in the United States nor do we have more people who hold extremist ideology. What we do have are more legally purchased, military-grade weapons in the hands of a civilian population than any other comparable country. An overwhelming number of mass shootings involve assault weapons.

One popular definition of insanity is doing the same thing over and over again and expecting different results. Only one intervention could make a difference in the increasing number of heartbreaking mass shootings. Military-grade semiautomatic weapons and their high-capacity magazines should not be available to civilians with or without mental illness or fanaticism. Moreover, as the Newtown, Conn., families are doing in their lawsuit against Remington Arms, the manufacturers who sell and market such weapons to civilians must be held legally accountable for valuing their profits over our lives.

So the next time you hear another politician harp on more vigorous control of mental illness as a means control gun violence, consider what the mental experts have to say on this subject, and vote accordingly!

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GMO UPDATE: WHEN “DO GOODERS” CAN BE “DO BADDERS”

       Cereal GMO         As I reported previously, (http://www.mortontavel.com/2013/06/21/) there is danger in labeling plants and foods as “genetically modified.” (GMO). Sadly, organizations with titles that sound helpful, such as Greenpeace, Consumer’s Union, Organic Consumers Association, etc., are actually pandering to irrational fears, to the detriment of a world that will, in the future, be desperately in need of adequate food supplies. They are urging governmental mandates to label all such foods as specifically modified in this fashion. In order to set the record straight, many distinguished scientists have come out with a powerful statement:

Nobel Laureates blast Greenpeace’s anti-GMO activities:.

More than 100 Nobel Prize winners have signed an open letter to promote the use of genetically modified plants and reject the views of its opponents. The letter states:

  • Global production of food, feed, and fiber is expected to have to double by 2050 to meet the demands of a growing global population.
  • Scientific and regulatory agencies around the world have repeatedly and consistently found crops and foods improved through biotechnology to be as safe as, if not safer than those derived from any other method of production.
  • Despite this, organizations opposed to modern plant breeding, with Greenpeace at their lead, have opposed biotechnological innovations in agriculture; misrepresented their risks benefits, and impacts; and supported the criminal destruction of approved field trials and research projects.
  • Greenpeace has led the opposition to Golden Rice, which has the potential to reduce or eliminate much of the death and disease caused by vitamin A deficiency (VAD), which causes 1 to 2 million preventable deaths each year, mainly among the poorest people in Africa and Southeast Asia.
  • VAD is the leading cause of childhood blindness globally affecting 250,000 to 500,000 children each year, half of whom die within 12 months of losing their eyesight.

The signers urge Greenpeace and its supporters to recognize the findings of scientific bodies and regulatory agencies and abandon their campaign against “GMOs” in general and Golden Rice in particular. They also urge governments of the world to oppose Greenpeace’s actions and accelerate farmers’ access to all the tools of modern biology, especially seeds improved through biotechnology. The Support Precision Agriculture Web site lists the laureates and more than 2,500 others who have joined the campaign so far.

The current move by several states to mandate labeling of all foods modified in this way sends a misleading message to the public, suggesting that these foods are somehow “tainted” or less safe. Nothing could be further from the truth!

    I, for one, wholly endorse the scientists’ initiative!

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Science Weighs In on High Heels

shoes

Obviously, what we wear on our feet affects how our bodies move. People who run barefoot, for instance, are more likely to land near the front of the foot with each stride than people wearing typical running shoes, who more commonly land on their heels.

But few other shoes affect the shape and functioning of the foot as dramatically as high heels do. According to a recent review of the available research about footwear, walking in high heels can alter the natural position of the foot-ankle complex, and thereby produce a chain reaction of effects that travel up the lower limb at least as far as the spine.

But while it’s clear that the feet and ankles of women who wear such heels over a long period of time are different from those of women who usually wear flats, the progression of theses changes has not been well understood.

A recent study published in The International Journal of Clinical Practice, researchers in South Korea turned to a handy recruit group: young women at the university studying to become airline attendants who were required to wear high heels to class, since they would have to wear them if hired by a Korean airline. With each passing year, from incoming freshmen to seniors, the women would have one additional year of heel wearing behind them, making it easy to track physiological changes.

The results were interesting. Compared with the freshmen, who were generally new to wearing heels, the sophomores and juniors displayed greater strength in some of the muscles around their ankles, particularly those on the inside and outside of the joint. Although this difference between new and experienced heel wearers suggested that wearing high heeled shoes may at first lead to adaptation and increased strength, the senior women, who had been wearing heels the longest, showed weakening of those same muscles, compared even with the freshmen, as well as much weaker muscles along the front and back of the ankle, resulting in dramatically worse balance. In fact, all of the upperclasswomen had worse balance than the freshmen, even as some of their muscles were strengthening. What appeared to have been happening is that the ratio of strength between the muscles on the sides of the ankles and those at the front and back became increasingly unbalanced over years of wearing heels, contributing to ankle instability and balance problems and eventually to a decline in the strength even of those muscles that had been stronger for awhile.

This finding is worrisome because strength imbalances in the muscles around a joint, especially those around the ankle, are known to increase injury risk in other muscle groups, such as those in the hamstrings or upper leg.

So should women give up wearing high-heels altogether? If it’s possible, I would respond with an emphatic yes! However, if such shoes are unavoidable, wearing should be minimized as much as possible. Moreover, people who often must wear high heels should strengthen their ankles whenever possible with simple heel lifts, where one stands barefoot and then rises onto the toes repeatedly; and heel drops, during which one stands on the edge of a stair, slowly lowering the heels over the edge.

Whenever possible, slipping off heels while sitting at one’s desk should be done, since wearing the shoes, even when not moving can alter the resting length of the muscles and tendons around the ankle, which could destabilize the joint and increase the risk of injury.

Also never run purposely in heels. The impact forces created are concentrated over a small region of the foot in high heels, creating regions of very high pressure, often resulting in foot pain. Additionally, balance and biomechanics are compromised, making running in heels a very inefficient way to move.

In conclusion, whoever invented high heels should themselves be required to wear them 24-7; perhaps then they would learn to be careful of what they had wished for!

 

 

 

 

 

 

 

 

 

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NRA REACHES YOUR DOCTOR’S OFFICE

gun home

As a physician, I had always prided myself on being free to advise patients about all health issues, including risks that could endanger their personal well-being and that of their families and loved ones. This meant that I could inquire not only about immediate risks such as smoking and diet, but, among others, about whether a patient was using his/her seat belt when driving, or exposing family members to the toxic effects of secondary cigarette smoke in the home. I was also free to inquire whether a given patient had a firearm at home, because of the potential dangers involved. In that regard, evidence shows that the presence of a gun in a home increases by threefold the risk of death for all household members, especially by suicide, when compared with homes free of guns. Even worse, this risk rises to fivefold greater for children residing in homes possessing firearms. Thus these dangers are so great that it is incumbent on physicians to counsel patients about risks of home firearms and to recommend countermeasures, which include use of safety devices and meticulous storage of weapons, or better yet, total removal of guns from the household.  This is so important that all major physicians’ organizations, including the AMA, have recommended that physicians discuss firearm safety with their patients.

So can such responsibilities be forbidden? Outrageously, Florida’s Firearm Owners’ Privacy Act was enacted in 2011 in response to concerns raised by some patients whose physicians asked them about gun ownership. The law prohibits physicians from intentionally entering information into a patient’s record about firearm ownership that “is not relevant to the patient’s medical care or safety, or the safety of others.” Thus physicians my not ask about firearm ownership unless they believe “in good faith” that “such information is relevant to the patient’s medical care or safety, or the safety of others.”  Physicians who violate this law may be “disciplined” (whatever that means). Whew! How disingenuous can a law be?

Now several physicians and their organizations are rightly suing the Governor of Florida, claiming that the law violates the First Amendment. Subsequently, a 3-judge panel of the Florida Court of Appeals voted to uphold the Act. Although the legal interpretations were mixed, this court believed that physician counseling may be so persuasive as to deter patients from exercising their second amendment right to own guns. But they got it wrong! This amendment doesn’t protect anyone from hearing information about the risks of firearms. As a matter of fact, some limited studies suggest that gun owners counseled in this way are more likely to change storage and handling practices, thus reducing the odds of gun-related catastrophes.

This case is still being contested, and the associated First Amendment issues are apt to be major. Missouri and Montana already have laws similar to Florida’s, which have been (not surprisingly) strongly supported by the NRA.  In 2011, the West Virginia legislature even considered a law that defined physicians’ questions about gun ownership as gross negligence.

If the Florida law is upheld, additional states may then enact similar restrictions, endangering physicians’ ability to counsel patients about gun safety. Even more egregious, this could lead to more invasive regulation of physician counseling; for instance, several states already require doctors to provide women—often against their wishes—with medically questionable information prior to abortions. All such laws threaten to compromise the physician-patient relationship, which relies on truthful and confidential communication in order to arrive at shared health goals. These laws unduly reflect the invasion of a physician’s ability to speak truthfully in the effort to protect a patient’s own health as well as that of their families.

Perhaps the NRA is creating more mischief than merely protecting the Second Amendment!

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EXERCISE CAN PREVENT CANCER: NEW INFORMATION

EXERCISE

We have long known that regular exercise can prevent cardiovascular disease. For the past 20 years, however, evidence has been accumulating that exercise can prevent many cancers. The list of potentially preventable cancer types has been growing including many that were heretofore unsuspected.

Regarding cancer in men, prostate cancer is the most prevalent form, being diagnosed in approximately 223,000 men yearly, but fatalities are relatively low, at 29,000.

Lung cancer is found in about 110,000 yearly, and causes death in 88,000

Colorectal cancers are diagnosed in 72,700 men, and fatal in 27,000.

In women, a whopping 230,480 new cases of invasive breast cancer are being diagnosed yearly in the U.S. A total of 39,500 are expected to die from this disorder.

THE ROLE OF EXERCISE

In 2003, a paper in the journal Medicine & Science in Sports & Exercise reported that more than a hundred population (epidemiologic) studies on the role of physical activity and cancer prevention have been published. The authors noted that:

    “The data are clear in showing that physically active men and women have about a 30-40 percent reduction in the risk of developing colon cancer, compared with inactive persons … With regard to breast cancer, there is reasonably clear evidence that physically active women have about a 20-30 percent reduction in risk, compared with inactive women. It also appears that 30-60 min/day of moderate- to vigorous-intensity physical activity is needed to decrease the risk of breast cancer, and that there is likely a dose-response relation.”

    These studies were collected mainly by questionnaires about exercise regularity and subsequent development of cancers. Although this type of information is convincing, we now have even more conclusive results derived from careful assessment of physical fitness and development of cancer, at least in men.

According to a 20-year, prospective study of more than 17,000 men at the Cooper Institute in Dallas, Texas, measured levels of cardiorespiratory fitness appear to be as predictive of cancer risk and survival as they are of heart disease risk and survival.

Their data showed that the risks of lung and colorectal cancer were reduced 68% and 38%, respectively, in men with the highest level of cardiorespiratory fitness, compared with those who were the least fit.

Although cardiorespiratory fitness did not significantly reduce prostate cancer incidence, the risk of dying was significantly lower among men with prostate, lung, or colorectal cancer if they were more fit in middle age.

Although prior studies have shown that being physically active is protective against cancer, this study is unique because it looked at a very specific marker – cardiorespiratory fitness as measured by maximal exercise tolerance testing.

What was unexpected was that evidence of fitness not only predicts prevention of cancer but also even mortality after cancer has already been diagnosed.

Thus quantitative measurements of fitness might be compared with measuring your cholesterol, providing us with a very specific number to target. Merely asking someone about his/her physical activity doesn’t provide that information.

The 17,049 men in the study underwent exercise tolerance testing with a treadmill or bicycle and risk factor assessment at an average age of 50 years as part of a long term study. Metabolic equivalents (METs) were used to record the men’s cardiorespiratory fitness (CRF) and to place them into five CRF quintiles. Lung, colorectal and prostate cancers were assessed using Medicare claims data at Medicare age, and cause-specific mortality was determined after cancer diagnosis.

Over the 20 years of follow-up, 2,885 men had been diagnosed with prostate, lung, or colorectal cancer, and of these, 769 died. .

Compared with men in the lowest CRF fitness quintile, hazard ratios for developing lung and colorectal cancer men in the highest fitness group were 68% lower for lung cancer and 32% lower for colorectal cancer, after researchers adjusted for such risk factors as smoking, body mass index, and age.

In men who had already developed all these cancers, mortality also declined across the higher the fitness groups.

Even a modest increase in fitness reduced the risk of dying from cancer and cardiovascular disease by 14% and 23%, respectively.

Another striking finding is that even if men aren’t obese, they still have an increased risk of cancer if they aren’t fit, suggesting that everyone can benefit from improving their fitness. The findings also suggest that, ideally, individuals should be advised that they need to achieve a certain fitness level, and not just be told that they need to exercise

The study did not evaluate whether a particular type of exercise contributed more consistently to cardiovascular fitness, but in general, activities performed at high intensity, regardless of type, are the best way to improve fitness.

New data now extend our knowledge even further: A large recent study confirms that exercise lowers the risk of many different types of cancer, but now it goes a step further: It shows just how much the reduction is for each type.  The study was of of 1.4 million people carried over 11 years and disclosed that people who exercised the most had a variable, but extensive reduction of risk for many. They found the following:

Those exercising the most had the percentage risk reductions for cancers in the following locations:

  • Esophagus—42%
  • Liver—27%
  • Lung—26%
  • Kidney—23%
  • Stomach—22%
  • Uterus (Endometrium)—21%
  • Myeloid Leukemia—20%
  • Myeloma—17%
  • Colon—16%
  • Head and Neck—15%
  • Rectum—13%
  • Bladder—13%
  • Breast—10%

Although additional research will be needed to quantify exactly how much exercise will prevent cancer, the message is steadily clarifying itself:  Plenty of exercise is fit for all, and probably the more the better!

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CHOCOLATE CAN BENEFIT HEALTH. HERE IS THE LATEST

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In recent years much has been written about the health value of dark chocolate. Much—but not all—chocolate contains a class of so-called “flavinoids,” or “flavanols,” which are widely present in cocoa, green tea, red wine and some fruits. These components seem to be helpful in lowering blood pressure and improving cardiovascular health.   Most research indicates that cocoa or dark chocolate, consumed daily, produce beneficial effects on human health, consisting of a modest reduction in blood pressure with dilation of arteries, resulting in increased circulation to various organs (the brain for one, perhaps most notably).  Consuming milk chocolate or white chocolate, or drinking fat-containing milk with dark chocolate, appears to largely negate the various health benefits.

For instance, survivors of heart attacks who eat chocolate at least two or three times a week reduce their risk of death by a factor of up to three times compared to survivors who did not eat chocolate. These apparently beneficial effects seem to derive from the positive role of cacao and cocoa products on cardiovascular risk factors such as blood pressure, cholesterol levels, atherosclerosis, and improving how the body handles insulin (potentially helping diabetes, another potent risk factor).

But the picture is not without drawbacks, for over-consumption of chocolate can have harmful effects such as weight gain and obesity. Moreover, chocolate that contains the most flavanols seems to confer the most benefit, whereas that being poor in these components possess little, if any, benefit.

EFFECTS ON BRAIN FUNCTION

Recently, researchers from Columbia University in New York gave 37 trial participants, aged between 50 and 69, a drink containing cocoa for which flavonols were extracted from cocoa beans. The amount of flavonols consumed varied: Half of the participants received 900 mg daily; the other half received only ten milligrams.

Then the scientists measured the blood flow in the brain. In the flavonol-rich group, a higher circulation was found. Moreover, the participants of this group achieved significantly better results in memory tests. If a participant had the memory of a typical 60-year-old at the beginning of the study, “after three months that person on average had the memory of a typical 30- or 40-year-old”, said study author Scott Small. However, the study did not include participants with dementia or similar conditions, but did include people with healthy memory and age-related memory declines, the authors emphasized.

Supporting of these findings, another study of thirty–two healthy participants underwent two baseline sessions after one night of undisturbed sleep and two experimental sessions after one night of total sleep deprivation. Two hours before each testing session, participants were randomly assigned to consume high or low flavanol chocolate bars. Indirect measures of blood flow to the brain were also studied.

Interestingly, after sleep deprivation, those who received high flavanol chocolate showed no decrease in the expected loss of memory, whereas those receiving low flavanol chocolate failed to retain memory in much the same way as normal loss of sleep produces. Moreover, these results correlated with changes in blood flow to the brain, i.e., those receiving high flavanol chocolate showed evidence of more blood flow to this organ.

Not All Chocolate Is Created Equal, but greater Benefits likely from more Flavanol
One of the biggest challenges in comparing the research on chocolate and health is the wide variety of the types of chocolate consumed. While clinical trials most often use dark chocolate, which can vary greatly in flavanol content, epidemiologic studies have examined overall chocolate consumption, including dark and milk chocolate. Unfortunately, flavanol-rich cocoa and chocolate products have a distinctly bitter taste.

Milk chocolate, which is the most widely consumed chocolate in the United States, is much lower in flavanols than dark chocolate. But even dark chocolate can vary greatly in flavonol content, depending on the amount of cocoa solids it contains and how it’s processed. Flavanol content even varies among crops of cacao beans. Manufacturers typically purchase cacao beans from several countries and from many suppliers and then combine them. This practice results in varying flavonoid levels from batch to batch of chocolate produced.

The labeling of the flavanol content of chocolate products isn’t mandatory, but as a general rule, the higher the percentage of cocoa solids in a chocolate product and the more bitter the taste, the higher the flavanol levels. But while this association isn’t consistent, it‘s the best indicator available of flavanol content. And then, of course, there’s white chocolate, which isn’t chocolate at all; it contains zero flavanols.

So what should the individual do about chocolate? Be aware that most chocolate products are high in sugar, fat, and calories. While much of this fat is the kind that doesn’t raise cholesterol levels, it does add a significant number of calories. It’s not wise to add a daily dose of chocolate if it’s not already part of your diet, especially if you’re overweight or obese. However, some researchers have suggested that if total calorie intake is balanced, chocolate flavanols can be part of a healthful diet in general, especially for those with high blood pressure. If you are a chocolate lover who regularly indulges, choose dark chocolates that are high in cocoa solids and therefore usually rich in heart-healthy flavanols. Increasingly, dark chocolate products are providing the percentage of cocoa solids on the label, and some newer varieties, such as CocoaVia, are even listing the amount of flavanols on the label, boasting as much as 350 mg per serving.

Despite these touted health benefits, Americans overwhelmingly prefer the taste of milk chocolate over dark—and we’re not alone. A study from Australia found that one-half of the participants in a 24-week period said it was hard to eat 50 g (about 3 oz) of dark chocolate every day, and 20% said it was an unacceptable long-term treatment option. Yet the truth is the darker the chocolate, the more bitter the taste and the more healthful it is for the heart. What a bummer!

The bottom line? Clearly, not everyone is a fan of dark chocolate, but it’s the one to consume for heart health. Eating too much chocolate, like any high-calorie snack, can have harmful effects, but the research strongly suggests a potential health benefit from regular consumption of dark, flavanol-rich chocolate as part of a healthful diet. But the refrain from researchers is the same: We need more research before we can make any definitive recommendations.

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“NATUROPATHIC” TREATMENT—SAFE OR DANGEROUS?

Naturopathy
The name “naturopathic” sounds innocuous, but is it really? Every year, naturopathic students and practitioners go to Washington D.C. to lobby for naturopathic medicine during an event called the DC Federal Legislative Initiative, DCFLI for short. The event is organized by the American Association of Naturopathic Physicians (AANP). All naturopathic students are heavily encouraged to be politically active. Naturopaths simply have too much at stake, for, unfortunately, their massive amounts of student loan debt is on a par with that of graduates from real medical schools.
As one former naturopathic student stated, “I went on to practice in Arizona and Washington for three years before learning that naturopathic medicine is based on discredited and dangerous practices without any demonstrable medical basis. I now advocate against the naturopathic profession, state licensure of naturopaths, medical scope expansion, and inclusion in health care programs such as Medicare and Medicaid. It is my opinion, as a former naturopath, that naturopathic practitioners cause more harm than good”.
Naturopathy is based upon Falsehoods
Falsehood #1: Naturopathic doctors are trained as primary care physicians. Fact: The education and clinical training of naturopathic doctors takes place entirely outside of the medical education system. The naturopathic system has been designed and managed by other naturopaths and positioned in such a way to avoid external review. There is no oversight by medical professionals or academic educators. Naturopathic schools teach students pseudoscientific theories for the diagnosis of real and fake diseases and perpetuate the use of debunked and scientifically implausible treatments.
Here are some facts about naturopathic education based on a student’s training at Bastyr University, considered “The Harvard of naturopathic medicine”:
• 88 hours in homeopathy and 146 hours in herbalism
• 198 hours in combined massage, water therapy, and chiropractic
• 55 hours in pharmacology
• 850 hours of “clinical” training directly on patients
• No standards of care
• Lots of anti-vaccine promotion
• No required residency
For comparison, by the time an actual primary care physician finishes residency training, he or she has completed about 20,000 clinical training hours and seen tens of thousands of patients.
Falsehood #2: Naturopathic physicians have attended 4 year accredited medical schools. This one is especially outrageous. Naturopathic programs are accredited by the Council for Naturopathic Medical Education (CNME). This agency operates independently from the Liaison Committee for Medical Education (LCME), which accredits medical schools in North America. The LCME does not accredit naturopathic programs. This lie is being used to create a false equivalency between naturopathic school and medical school.
The U.S. Department of Education (DoED) does not directly accredit schools or programs. Instead, it uses private accrediting agencies for this task. Accreditation of a school or program reflects adequate administration, organization, and operation of the institution. It is not a stamp of approval by the DoED for any curriculum.
The LCME is a reputable organization staffed by medical professionals and academic educators. On the other hand, the CNME is run by naturopaths and chiropractors.
Falsehood #3: Naturopathic students take all the same courses as medical students. This statement is misleading, for although naturopathic students take basic science courses that allegedly parallel courses offered in medical schools, this is an irrelevant point that distracts lawmakers from the most important part of medical training that naturopaths lack: a genuine medical residency based upon sound scientific principles with proper supervision by physicians. The skills and expertise needed for practicing medicine are not acquired in basic science courses, such as histology. The practice of medicine is learned during a physician’s residency and fellowship programs. According to the American Medical Association, The education of physicians in the United States is lengthy and involves undergraduate education, medical school and graduate medical education. (The term “graduate medical education” includes residency and fellowship training.) Completing basic and clinical science course work and then passing licensing exams does not allow medical graduates to practice medicine independently. They must complete residency training. Medical schooling alone is not enough training.
Falsehood #4: Naturopathic medicine is safe and natural. This one is way off base, primarily because naturopaths love dietary supplements. The problem is that the Food and Drug Administration does not regulate dietary supplements in the same way that prescription drugs are regulated, falling under a regulatory framework that operates independently from the FDA. Thus this latter agency is not authorized to review dietary supplement products for safety and effectiveness before they are marketed. According to the National Institutes of Health Office of Dietary Supplements, supplements are most likely to cause side effects or harm when people take them instead of prescribed medicines or when people take many supplements in combination. To this, the FDA agrees: “mixing medications and dietary supplements can endanger your health.”
Sadly, the sale of dietary supplements out of naturopathic clinics is a mainstay of naturopathic practice. Most naturopaths sell dietary supplements directly to their patients for a large profit margin after prescribing them for health benefits. This is a glaring conflict of interest. As a matter of fact, Emerson Ecologics, a company that sells supplements to naturopaths for resale, is financially supporting naturopathic lobbying and state licensing efforts. Its scientific advisor is the president of the American Association of Naturopathic Physicians. Naturopaths claim the supplements they sell in their offices are higher in quality than the ones sold at health food stores. There are no data to support this claim. It is further troubling that dietary supplements often contain undisclosed or adulterated ingredients, which pose a great danger to those with allergies and those taking prescription medications.

Falsehood #5: Naturopathic medicine is good for America: Most relevant to the political advancement of naturopaths is the predicted primary care physician shortage by 2025. Naturopaths aspire to fill this gap by becoming licensed in as many states as possible, with scopes of practice that would allow them to act as medical doctors. This possible future is a dangerous one. Although we need more physicians, nurse practitioners, and physician assistants, we do not need naturopaths!
More naturopaths can lead to the following outcomes:
• Higher health care costs for patients. Naturopaths frequently need to refer their patients to medical professionals for the management of chronic and acute illnesses.
• Increased medical errors due to accidental herb/supplement-drug interactions and missed diagnoses.
• Increased spending on discredited practices such as homeopathy, esoteric blood tests, essential oils, high-dose vitamin injections, detoxification, coffee enemas, or ozone gas therapies.
• Increased confusion for patients that the U.S. government endorses disproved and implausible practices by practitioners without acceptable scientifically based medical training.
• Increased number of unvaccinated children, leading to a higher prevalence of vaccine-preventable diseases. Naturopaths overwhelmingly do not support vaccination.
Obviously, the primary impact of naturopathy is negative, but naturopaths will present sugar-coated arguments that are emotionally appealing. Lawmakers need to be educated about the true nature of this menace. America deserves medicine that is based on science, not fringe practitioners who take shortcuts and whose interests are conflicted.

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