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.


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.


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!



       Cereal GMO         As I reported previously, ( 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!


Science Weighs In on High Heels


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!












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!




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.


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!



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.





All of us have heard the expression, “I am worried to death!” But is this merely a figure of speech, or is there any literal truth to such a statement? So let’s take a look at what science has to offer:

Multiple studies have shown that people who are lonely and depressed are over three times more likely to get sick and die prematurely—in contrast to people who are not depressed, and especially those who have a stronger sense of love, connection, and community. For example, one report disclosed that 6 months after a heart attack, people who were depressed were four times more likely to die than those who weren’t depressed. This was independent of the usual risk factors like cholesterol, blood pressure, weight, and even smoking. Consistent with that observation, there have been hundreds of studies showing that people who are lonely and depressed are many times more likely to get sick and die prematurely—from all causes as well as heart disease—when compared with those who have a strong sense of love, connection, and community. Such observations are consistent with studies that have shown that being married—at least happily—are actually good for your heart. In one recent survey out of New York University’s Lagone Medical Center, researchers found that married men and women had a five percent lower chance of cardiovascular disease compared to single people. We aren’t entirely sure why, but it’s possible that since marriages typically offer a person emotional support, physical and intellectual intimacy, as well as deeper social ties to family, they might improve overall health.  Consistent with this concept, one study found that people in a bad marriage were actually more likely to experience negative cardiovascular effects, compared to people in good marriages. Thus it’s not necessarily about whether you’re married or not, it’s all about how happy it’s making you.

This raises the question of whether the adverse outcomes are due to the emotional disruption or to the poor lifestyle choices made by those who are depressed or nervous. It is true that some people who are lonely and distraught are more likely to do things that are self-destructive, for example, smoke excessively or fail to take medicines as prescribed. But these explanations seem to fall short of the real truth, as explained below.

There are ways that mental health issues can directly affect heart disease, as reflected in the growing belief that depression and anxiety are risk factors that are even more dangerous than others such as diet. Stress can increase hormones like adrenaline and cortisol, and can impact one’s blood pressure and heart rate in an unfavorable way. Moreover, people with depression have been found to have uncommonly sticky platelets, the tiny cells that cause blood to clot. In patients with heart disease, this can accelerate atherosclerosis (hardening of the arteries) and increase the chance of heart attack. Some studies suggest that treating depression makes platelets less sticky again.

Even animal studies have demonstrated that positive emotional support can foster better health. One study dealt with atherosclerotic rabbits.  Rabbits were put on a high-cholesterol diet with the assumption that they would all get heart disease. The rabbits were stacked in cages up to the ceiling, and the ones up high got heart disease a lot more than the ones in the lower cages, which made no sense. What they found was that the lab technician, who was short, would come in to feed the rabbits and would play with the ones in the lower cages because she could reach them, and she would ignore the ones in the higher cages. The study was repeated with genetically comparable rabbits fed the same diet, and they randomly divided the rabbits into two groups. With one group they would take the rabbits out of the cages, play with them, and love them They found that the rabbits that were touched, talked to, petted, and played with had 60% less atherosclerosis than those that were ignored, even though their serum cholesterol levels, heart rate, and blood pressure were comparable.

Similar findings have been reported with male monkeys, for those that were stressed had significantly more extensive coronary artery atherosclerosis compared with a control group of monkeys that weren’t stressed, even though their cholesterol, blood pressure, blood sugar, weight, etc. were not different.

In medicine, we focus on what we can see and measure easily. We can measure cholesterol and blood pressure easily so we tend to focus on those things. The American Heart Association still doesn’t list emotional stress in their seven key modifiable risk factors. There is a saying that not everything that counts can be counted. In other words, not everything that is meaningful is measurable. We tend to focus on what is easily measurable, even though these psychosocial factors are probably as important—and in some ways, even more so.  Scientists are getting more innovative at measuring these factors. In a recent study, researchers analyzed 148 million Twitter messages (tweets) across the United States and found that language patterns reflecting negative social relationships, disengagement, and negative emotions—especially anger—were risk factors for heart disease at a county level and were even more predictive than smoking, diabetes, hypertension, and obesity. In contrast, positive emotions and psychological engagement were protective.

Maintaining a positive attitude about treatment and holding the belief that our actions can have a beneficial effect on our own health are very important. A person’s attitude seems to have a powerfully favorable effect on their ability to make behavior and lifestyle changes that are often necessary to reduce the risk of having future health problems. A person’s attitude also influences the response to treatment.

So what can we do about these emotional problems, and can countermeasures alter one’s odds of survival?

Although treatments such as psychotherapy and drugs are often used to improve emotional status, the results of such measures are complicated and difficult to measure, leaving us in doubt about their individual effects on survival. Regular exercise, however, has been proven to reduce both depression and risk of disease. Various studies have shown that participation in exercise training programs was comparable to treatment with an antidepressant medication (a selective serotonin reuptake inhibitor) for improving depressive symptoms in older adults diagnosed with major depression.  Exercise per se also offers significant protection against heart disease and many cancers as well.  Included among the many benefits of regular exercise is the lessening of the likelihood of upper respiratory infections and reduction of the severity of symptoms if you do get one. The reason for this protection is unclear, but exercise’s demonstrated reduction of inflammation and its boosting of general immunity in the body may play a role.


Although it’s difficult to separate and determine the effects of pure emotional support on survival, it is highly likely that such countermeasures are effective. Regardless, however, combating depression and anxiety and promoting more social interaction that include love and respect are beneficial goals in themselves, making for a happier and healthier individual, and hopefully, a longer life as well!




For a host of legal and political reasons as well as the scarcity of lethal drugs for injection, the number of executions has declined in the U.S. to just 28 in 2015, compared with a recent peak of 98 in 1999. Because of difficulties in obtaining lethal drugs, some states have approved alternative means such as firing squad or gas chamber as more “delectable” means of dispatching wrongdoers. Methods by state are summarized below:

  • Electrocution in Florida, Oklahoma and Tennessee.
  • Gas inhalation in California, Missouri, Oklahoma and Wyoming.
  • Hanging in Delaware and New Hampshire.
  • Firing squad in Oklahoma and Utah.

But this controversy invites the larger question of whether there is any overall justification for this, the severest, of penalties. (Full disclosure here: I am firmly opposed to the death penalty under any circumstance, which is in agreement with a total ban by most civilized western societies!)

Although my reasons for opposition to executions are complex, they can be boiled down to a few simple principles: 1) Some condemned persons are, by virtue of later evidence, proven innocent, 2) It is impossible to apply equal justice to many disadvantaged individuals representing minorities or the poor 3) No credible scientific studies have ever shown that capital crimes can be reduced by this threatened means, 4) It is not only more humane, but also less expensive to levy life sentences in preference to forcing inmates to sit endlessly in death rows while progressing through a seemingly endless sequence of appeals.

As a physician, I have always been committed to preventing both death and suffering, and in this capacity, have tried to avoid either of these events as much as possible. As I explained in a previous post: However, in the case of extreme suffering, I believe that physician assisted suicide is acceptable when patients request it, are of sound mind, and no better alternatives to sparing life are available.

By contrast, I do not believe that physician assisted murder (AKA execution) is ever permissible, and that is why most of my fellow physicians are unwilling to participate in such a repugnant and gruesome spectacle. So by default, the actual practice of execution by lethal injection often is relegated to medical surrogates who are less well trained and more apt to botch these procedures, especially when they are supplied with inferior or unproven drugs.  Adding to this problem, corrections officials often conceal how drugs are obtained, and, therefore, lawyers for condemned inmates have challenged these efforts to mask this information, saying this makes it impossible to know if drug concoctions meet quality standards or might cause undue suffering. “States are shrouding in secrecy aspects of what should be the most transparent government activity,” said Ty Alper, associate director of the death penalty clinic at the University of California, Berkeley, School of Law

Before Missouri put to death a prisoner recently, for example, it refused to say in court whether the lethal barbiturate it used, pentobarbital, was produced by a compounding pharmacy or a licensed manufacturer. A majority of the 32 states with the death penalty have imposed secrecy around their drug sources, saying that suppliers would face severe reprisals or even violence from death penalty opponents. In a recent court hearing, a Texas official argued that disclosing the identity of its pentobarbital source “creates a substantial threat of physical harm.”

Recently, the giant pharmaceutical company Phizer decided against provision of drugs for executions. This move followed its acquisition last year of Hospira, a company that has made seven drugs, including barbiturates, used in executions, a combination of agents that cause paralysis and heart failure. Hospira had long tried to prevent diversion of its products to state prisons but had not succeeded; and its products were used in a prolonged, apparently agonizing execution in Ohio in 2014. They are stockpiled by Arkansas, according to documents obtained by reporters. Because these drugs are also distributed for normal medical use, there is no way to determine which of the agents used in recent executions were produced by Hospira or Pfizer.

Campaigns against the death penalty, and Europe’s strong prohibitions on the export of execution drugs, have raised the stakes for pharmaceutical companies, and many, including Pfizer, say ethical concerns have also guided their policies. “Pfizer makes its products to enhance and save the lives of the patients we serve,” the company said in Friday’s statement, and “strongly objects to the use of its products as lethal injections for capital punishment.” Pfizer said it would restrict the sale to selected wholesalers of seven products that could be used in executions. The distributors must certify that they will not resell the drugs to corrections departments and will be closely monitored.

Despite all this controversy, however, it seems probable that the Supreme Court will soon have the final word, and given its likely makeup coming soon, we may see the end of the barbaric death penalty for all future generations, which is a positive step for this nation, if not for all humanity! And to that I would say let’s allow this penalty to suffer a natural death, in contrast to the many deaths that are ended unnaturally!

For further information about this issue, especially costs to the taxpayer, please visit the following website:


A Donald Trump Pyramid (Ponzi?) Scheme: Now Including “Snake Oil”


In 2009, Donald Trump started The Trump Network as a multi-level marketing (MLM) company to sell nutritional supplements and weight loss products in addition to home business marketing packages designed to recruit affiliates and earn commissions off their sales. The business was essentially rebranded by purchasing Ideal Health, Inc., a Massachusetts-based company that already sold health products through a vast pyramid structure.

The most effective way to profit as a member of The Trump Network was not to sell individual products, but to get others to sign up as members to sell more products and recruit more members. One could make lots of money by not selling any material products, but only by recruiting sellers and earning commissions off their sales.

The Federal Trade Commission has come down hard on pyramid schemes, but has run into trouble with ones that actually sell products within a pyramid-referral structure. There are differences between an MLM company and a pyramid scheme, but the distinction can be subtle and seems to depend on the proportion of revenue that comes from recruitment versus real product sales. The Trump Network, however, appears far less of a MLM and more of a pyramid scheme.

Let’s take a look at how the Trump Network concept was advertised. On the former Trump Network website in 2009, there was a letter posted by Donald Trump himself who pitches economic opportunity for families who were suffering financially from the Great Recession:

     At no time in recent history has our economy been in the state that it is today. The economic meltdown created by Wall Street greed, financial industry ineptitude and the mortgage crisis has hijacked the dreams of millions of people. We need a new plan to achieve financial independence. My experience in real estate has taught me that the greatest opportunities emerge when economic times are at their worst. That’s why, after the real estate crash of the 90’s, I came back stronger than ever. The first thing I learned is that when times are tough you need to hedge your bets. You need to diversify. The good news is: The Trump Network can provide you with a solution to help you and your family create a more secure future. Diversifying is a way to protect your income so that you can continue to do what you know and love, and still make money. The second thing I learned is that the economy goes in cycles. When some industries fail, others take off. For example, when the real estate industry was challenged in the early 90’s, the network marketing industry exploded. During hard times, people with an entrepreneurial spirit flock to network marketing opportunities. That’s why I have put my name and expertise into supporting this opportunity. The team at The Trump Network have phenomenal products, provide easy to follow training and have a great support network available to all their members. The Trump Network offers you a financial solution that you can believe in. The Trump Network offers products that help make people healthier, an opportunity for you to make as much money as you want, based on your own efforts, and the support of a great company. Join me in this worthwhile endeavor.

     Thus Trump pitched directly to suffering families by casting the venture in terms of success, money, and security. Potential customers are told to join him and prosper by selling health products through “network marketing,” which is a less loaded term than “pyramid scheme.” Although it may sound great to an economically desperate family member, a pyramid scheme cannot offer success to everyone in the affiliate network. The people at the top always win, and those at the bottom always lose.  To compound matters further, in this instance one is actually peddling junk, as explained below.

What was Trump Selling?

The company’s flagship product was called the PrivaTest, which supposedly relies upon a mail-in urine test to determine one’s individual nutritional needs and create a custom vitamin formula (about $140 for the test; $70 per month for the vitamins; $100 to retest every 6 months). From a scientific viewpoint, urine tests do not provide a legitimate basis for recommending that people take dietary supplements. Moreover, even if they could, the nutrients in the so-called customized formulas can be obtained far more inexpensively in retail stores. The Trump Network also acquired a weight loss program called The Silhouette Solution, which consisted of a book promising to lose the weight you want and have the silhouette you choose, which was included in the starter weight loss kit, all for a whopping $1,325. The package was marketed as “a complete eight-week program that contains everything you need to achieve your short and long term weight loss goals.” In it, they send you eight weeks worth of low-calorie food.

I could provide solid information on why this approach won’t provide benefit, especially in the long run, but as the skeptical nutritionist Janet Helm put it in 2009: “This [fake-food fad diet] is not only expensive, but an approach I certainly can’t support.”

But one more payoff: To make money in addition to losing weight, one could purchase the $400 business kit to market the product to their friends and family, or even be entrepreneurial enough to hold community seminars or purchase television ads to recruit more sellers.

Interestingly, Donald Trump’s foray into this sordid world of dietary supplements and weight loss products ended in 2012 when he sold The Trump Network to Bioceutica, LLC. Trump appears to have been concerned about the liability of being associated with a MLM (a.k.a. pyramid scheme) selling bogus products. As far as we know, however, Bioceutica is still operating and continues to sell the PrivaTest and the Silhouette Solution.

In 2016, the Washington Post reported that Trump claims that his involvement with Ideal Health merely allowed them to use his name for marketing purposes and that he was not involved in the company’s operations. But the paper noted that “statements by him and other company representatives—as well as a plethora of marketing materials circulating online—often gave the impression of a partnership that was certain to lift thousands of people into prosperity.”

In light of this illustrative example (and many others), if Donald Trump becomes president, the American people can continue to count on a lot of hyperbolic talk with very little intelligent leadership. There’s always money to be made selling snake-oil, maybe even to the entire world. Thus as the old cliché goes: Buyer Beware!





Dying As a physician, I originally supported the dictum that death should be prevented at all costs. But more recently, I have come to realize that perhaps we should also more seriously consider suffering as well as dying.

These thoughts have directed my attention to the so-called “aid in dying” laws that are in force in the U.S. states of Oregon, Washington, Montana, Vermont, and California. They are sometimes referred to as “Physician-Assisted Suicide”. These examples often require that a patient’s death be expected within six months, and they compassionately offer a voluntary, self administered end to suffering at an individual’s own preferred time. Since 2014, aid-in-dying bills have been introduced in Washington, D.C. and several states. Canada is also considering such a bill. Other countries, including Switzerland and Belgium, allow aid in dying for people who are not even terminally ill.  All these laws provide freedom for a physician to prescribe a lethal drug to a patient for self administration. At present, such a practice is unlawful in 46 states..

In the example of Oregon, which has had such a law in effect since 1997, subsequent study has uncovered no abuses, and, interestingly, about a third of patients who receive medication to end their lives never actually use it, meaning that many are likely reassured by the simple knowledge that they will be able to end their lives at any time of their choosing.

Although such laws are humane and sensible, they can be abused and result in wrongful deaths. We physicians commonly encounter severely depressed patients without life-threatening physical maladies who, on their own, might opt to commit suicide. In such instances, many can be encouraged to receive effective psychiatric care, and they can be restored to happy and productive lives. Obviously, in such cases a caregiver’s assistance in suicide would represent a serious disservice. Moreover, some individuals suffering from emotional illnesses that result in painful sensations can also be deterred from suicidal acts, receive proper medical treatment, and often enjoy a happy outcome.

Laws addressing such issues should be clearly defined. First, I believe a specific time for life expectancy need not be spelled out, for misery without hope doesn’t necessarily conform to a distinct number of days or months. For instance, someone suffering from a severe progressive neurologic disease such as Lou Gehrig’s disease (ALS) can continue suffering for many months prior to death. On a personal level, I witnessed the suffering and death of a patient/friend of mine from a similar neurologic disorder called progressive supranuclear palsy (PSP), a disease that also claimed the life of actor Dudley Moore, which is an uncommon progressive fatal brain disorder that affects movement, control of walking (gait), balance, speech, and many others. Given the choice, and if it were legal, my friend would have gladly opted to end his life by assisted suicide. Even various terminal cancers can behave for variable durations, and can also cause prolonged pain and suffering.

Using the successful example of Oregon, let’s examine its basic requirements: First, the patient must make two oral requests to the attending physician, separated by at least 15 days, accompanied by a written request, signed in the presence of two witnesses, at least one of whom is not related to the patient. The attending physician and a consulting physician must confirm the patient’s diagnosis and prognosis and determine whether the patient is capable of making and communicating health care decisions for him/herself.  If either physician believes the patient’s judgment is impaired by a psychiatric or psychological disorder (such as depression), the patient must be referred for a psychological examination. The attending physician must inform the patient of feasible alternatives to the act, including comfort care, hospice care, and pain control. The attending physician must request, but may not require, the patient to notify their next-of-kin of the prescription request. The attending physician will also offer the patient an opportunity to rescind his/her request at the end of the 15-day waiting period following the initial request to participate.

In most cases, the drug used for this purpose belongs to a group of so-called “barbiturates”, commonly used in lower doses for the induction of normal sleep. In large doses, however, death is painless, peaceful, and will occur within a matter of minutes to hours.

A death in this fashion is often far better than other, less desirable, alternatives. Thus I might conclude with a simple question: Isn’t it more humane to deal with one’s own species in a manner at least as appropriate as the smooth and painless exit we provide to our beloved animal pets?





Recent medical research, as reported in the highly respected New England Journal of Medicine, has provided us with both good and bad news about unwanted pregnancies:

First, the good news: The rate of unintended pregnancies in the U.S. has recently diminished. Less than half (45%) of pregnancies were unintended in 2011, as compared with 51% in 2008, declining by 18% overall in women between the ages of 15 to 44 years. While this reduction is not eye-popping, it represents progress, especially when compared with a minor increase between the years 2001 and 2008.

But now the bad news: Rates of unintended pregnancies during this last period among those who are below the federal poverty level are two to three times higher than the national average noted above.

Although the study explored several possible explanations for the reduction of unintended pregnancies, they concluded the most likely was an increased use of contraceptives, especially long-acting types such as intrauterine devices (IUDs) and hormonal injectable implants, both of which are relatively expensive. Although birth control is a basic and essential health care need for most women in all socioeconomic categories, those least able to afford these methods are placed at the greatest disadvantage.

Fortunately, the Affordable Care Act (ACA) requires that health insurers cover women’s preventive care services with no out-of-pocket costs. Although the ACA has brought the establishment of health insurance marketplaces nationwide and Medicaid expansions in 32 states, low-income women are disproportionately affected by limited information and access to the preferred methods. To fill this need, Planned Parenthood has constantly advocated for health care reforms and provided publicly funded programs that support expanding women’s access to all forms of birth control.

But here is where politics becomes the “fly in the ointment”. Those politicians with extreme views on reproductive health—often based upon incomplete facts and specious arguments—are trying to cut public funding for family-planning services through programs such as Medicaid and Title X, which have been critical in reducing costs and expanding access to preferred and effective contraceptives for low-income women.  Medicaid sources provide a range of methods that are twice as successful in comparison with those provided by similar providers that do not receive such funds.

But can we verify the negative consequences of such public fund withdrawals? The state of Texas provides a good (or bad?) example. Beginning in January, 2013, Texas withdrew support for Planned Parenthood affiliates from a Texas Medicaid fee-for-service family planning program. After the funding exclusion, there was a 35% reduction of provision of long-acting—the most preferred—forms of contraception, and during the same period, the number of pregnancies increased by 27%. The inescapable conclusion is that the vast majority of these births were unintended.

Sadly, withdrawing funds from Planned Parenthood has occurred in many states, including Ohio (Governor Kasich can bear responsibility there).  Unfortunately, Indiana is attempting similar action. Government agencies, such as local and county health departments, would be prevented from funding Planned Parenthood affiliates or abortion providers for services that include birth control as well as cancer screenings. Importantly, since the Hyde amendment was passed many years ago, Planned Parenthood has been denied the use federal funds to provide abortion services anywhere.

All these measures are obviously affecting those vulnerable women who are least able to provide support for unwanted children, or even their own health. Regardless whether one is for or against abortion—legal or otherwise—these data indicate that the numbers of these unfortunate souls seeking abortions by any means in states such as Texas are likely to increase in the future. Obviously, pregnancy, delivery, and early post-natal care are far more costly than preventive measures.

Sooner or later, the taxpayers will be penalized—directly or indirectly—and I for one subscribe to the old adage, “An ounce of prevention is worth a pound of cure”!

Our lawmakers would be well advised to stop the ill-informed decision to defund Planned Parenthood!