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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