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About the Author Dr. Tavel has recently completed a book for the general public entitled "Snake Oil is Alive and Well: The Clash between Myths and Reality--Reflections of a Physician". In it he presents an overview of how medical science has evolved over the past 200 years, how the underlying thought patterns in this field have progressed to overcome numerous biases and superstitions, and how many of these derived lessons can be applied to the public at large. Modern psychological and medical studies have demonstrated how biases and myths are formed, how pervasive they remain to this day, and how they can be recognized and combated. As a result, the book blends psychological and medical views that contain many valuable lessons for every individual. These include personal health issues such as facts and myths about diets, exercise, proper nutrition, vitamin supplements, and how to avoid frauds and rip-offs. The powerful influence of the so-called "placebo effect" in virtually all treatment encounters is reviewed in detail, and how these effects can explain the apparent success of such bizarre practices as faith healing, alternative medicine, chiropractic medicine, and acupuncture. But these same principles extend far beyond health issues to explain biases that produce mistakes by investors and analysts in financial and stock markets, basketball fans and coaches, gamblers, and even the errors of thought manifested by political and world leaders. Dr Tavel is aa lifelong native of Indianapolis, having received both college and medical degrees at Indiana University. After completing his undergraduate studies, he graduated summa cum laude and was elected to the honorary scholastic society of Phi Beta Kappa. Upon completion of his medical training, he was elected to the Alpha Omega Alpha for scholastic achievement in this field. His post-graduate specialized training included stints in Philadelphia and Salt Lake City. After serving in the U.S. Army Medical Corps for two years in Germany, he returned to Indianapolis to complete has training and to begin medical practice. Dr. Tavel is a physician specialist in internal medicine and cardiovascular diseases. In addition to managing patients for many years, he holds a teaching position (Clinical Professor) at Indiana University School of Medicine and regularly teaches medical students, house staff physicians, and other medical personnel. In addition, he has presented numerous speeches and lectures before national and international audiences that include peers as well as the general public. He is actively engaged in medical research and has authored over 100 research publications, editorials and book reviews that have appeared in peer-reviewed national medical journals. He is currently the director of the cardiac rehabilitation program at St. Vincent Hospital, Indianapolis, Indiana, and consulting cardiologist for the Care Group, Inc., a division of St. Vincent Hospital in Indianapolis. Dr. Tavel previously authored a book on cardiology that persisted through four editions over a period of approximately 20 years, and has been a contributor to several other multi-authored textbooks. His civic activities include, among others, having been past president of the local and state divisions of the American Heart Association. Video presentation about his current book can be found at http://www.youtube.com/watch?v=H7wVTbn1LEw&list=UU4F0O1bIh3zwYq6Vzmn-LwQ&index=1&feature=plcp


As I have stated, there is no justification for allowing prescription medicine to be advertised on TV: http://www.mortontavel.com/2017/03/28/. Why would anyone think of trying one of those medicines after listening to the laundry list of warnings of dangerous side effects? Moreover, if they posted their sticker prices, even more people would be turned off.

So, here is one with better results, more tolerable side effects, and definitely cheaper!

   Do you have feelings of inadequacy?

   Do you suffer from shyness?

   Do you sometimes wish you were more assertive?

   Do you sometimes feel stressed?

If you answered yes to any of these questions, ask your doctor or pharmacist if Cabernet Sauvignon is right for you.

Cabernet Sauvignon is the safe, natural way to feel better and more confident. It can help ease you out of your shyness and open you to world attention.

You will notice the benefits of Cabernet Sauvignon almost immediately, and, with a regimen of regular doses, you will overcome obstacles that prevent you from living the life you want.

Shyness and awkwardness will be a thing of the past. You will discover talents (and maybe some handicaps) you never knew you had.


Side effects may include the following:

dizziness, nausea, vomiting, incarceration, loss of motor control, loss of clothing, loss of money, delusions of grandeur, table dancing, headache, dehydration, dry mouth and a desire to sing Karaoke and play all-night Strip Poker, Truth Or Dare and Naked Twister.

The consumption of Cabernet Sauvignon may make you think you are whispering when you are not.

The consumption of Cabernet Sauvignon may cause you to tell your friends over and over again that you love them.

The consumption of Cabernet Sauvignon may cause you to think you can sing, when you can’t (at least on key).

The consumption of Cabernet Sauvignon may create the illusion that you are tougher, smarter, faster and better looking than most people.



Don’t take me too seriously! But can you recognize some parallels out there?






You may have been bombarded recently by hype about the magical healing power of stem-cell treatments. But before doing so, we offer some sobering information:

An investigation published recently in a major medical journali involving 368 Web sites that combined stem cell with various buzzwords and practitioner names associated with “complementary and alternative medicine” has disclosed the following:

  • 243 sites marketed stem cell therapies and 116 marketed other interventions where stem cells were mentioned in the description of the treatment or its effects. The other interventions included platelet-rich plasma injections and others.
  • The stem-cells used for transplantation were said to be derived from fatty tissue, bone marrow, blood, umbilical cord, and other sources, e.g., placenta, amniotic fluid, and embryonic stem cells.
  • 20 sites advertised plant cell-based treatments and products such as skin creams.
  • The most common advertised treatment targets were: bone, joint, and muscle pain/injury; various diseases or maladies; cosmetic concerns; non-cosmetic aging; and sexual enhancement.
  • 80% of the sites were for clinics in the USA; the rest were located in 17 other countries.
  • The practitioner types mentioned on the 368 sites included medical doctors (161), naturopaths (63), chiropractors (61), acupuncturists (36), midwives (33), homeopaths (27) and massage therapists (13). Some sites mentioned more than one and some sites listed none.
  • Hyperbolic language was found on 32% of the sites.
  • Only 31% of the sites mentioned the regulatory status of the intervention, and only 33% noted that the therapy was unproven.
  • Only 19% of the sites stated there was limited evidence of efficacy of the intervention and 13% said there was evidence of inefficacy.
  • Only 25% of the sites mentioned general risks of the interventions.

The investigators concluded:

Many clinics seem to be engaging in misrepresentation of science (pseudoscience), which can seriously obfuscate public discourse, mislead the public and make it difficult to discern real science from marketing claims that merely reference scientific sounding terminology. The marketing of unproven stem cell therapies has the potential to harm patients and to harm the reputation of stem cell science. It is incumbent on regulators and policymakers to take a proactive approach to managing the risks associated with the growing private market for stem cell-related interventions. Also, addressing misleading marketing practices is an important part of this strategy.

What real science has shown about stem cells ii

Stem cells are special cells with the potential to repair damaged tissue and organs, and they have been used in injections and tissue transplants in attempts to heal injuries and to treat various diseases. There are several types of stem cells, each possessing differing powers. Those that come from human embryos can turn into any kind of cell, and in theory, repair any organ or tissue in the human body. By contrast, those stem cells taken from fully developed tissues, called “adult stem cells” can only turn into the type of tissue from which they came, a feature that limits their use considerably.

Access to embryonic stem cells is federally monitored, but adult stem cells, which can be extracted from a patient’s own body, are subject to relatively few federal regulations. As a result, physicians and other non-licensed practitioners have been unimpeded in using them to treat a wide range of conditions without demonstrating that they are safe or effective. In fact, stem cell treatments are widely accepted only for two broad medical indications–to help treat a handful of blood disorders that include leukemia and some forms of anemia, and in certain cases to help burn victims.

The FDA has acknowledged the problem of under-regulated stem cell treatments and says it is taking steps to strengthen oversight of this burgeoning industry. Regulators have issued warning letters to numerous stem cell clinics for violating laboratory and manufacturing standards, and have ordered at least one company to stop selling any of these products. In the future, agency approval would be required for some stem cell therapies in a fashion similar to approval of prescription drugs. Clinics where patients are harmed would be subject so enforcement actions that could include increased inspections and possible product seizures. However, critics counter this proposed action by stating that those measures fall short of what’s needed to protect consumers, stating that such practitioners need to be prevented from selling dangerous untested treatments before they harm people, not after. Although much active research is taking place, the average consumer should be wary of any of these various schemes, even if emanating from recognized clinics such as Mayo Clinic, Northwestern University and the University of California, all of which have been accused of stem-cell over-hype in some instances.

So before anyone considers subjecting him/herself to a stem-cell treatment of any kind, obtain as much information as possible, especially from a well-recognized licensed medical practitioner involved in the same field of endeavor.

i Murdoch B et al. Exploiting science? A systematic analysis of complementary and alternative medicine clinic websites’ marketing of stem cell therapies. BMJ Open 8(2), March 2, 2018.

ii Interlandi J. Could this call save your life? Consumer Reports, March, 2018, pp 37-41.



Reverend Thomas Bayes (1702–1761) was an English clergyman who happened to be a fine mathematician, which was undoubtedly his first love. He formulated a theorem bearing his name, which allows for the mathematical calculation of probabilities of outcomes based upon certain preexisting conditions. Bayes’s formula remains pertinent to this day and is used by contemporary health professionals, psychologists, economists, physicists, and engineers. We medical practitioners apply this principle almost daily in evaluating the meaning of test results (Tavel, 2012). Now, however, this idea can be applied to politics.

The idea that Bayes introduced was conditional probability, i.e., the likelihood of a given outcome when prior baseline characteristics are already known. Nearly all methods of detection employ means that are not 100% accurate, and this means that any given model of prediction will omit outcomes that will eventually occur, as well as prediction of outcomes that fail to materialize. Thus Bayes provided a mathematical means to derive the actual probability of a later outcome after two variables are applied.

First let’s apply this idea to flying in a commercial airliner. Statistics show that such air travel is approximately 60 times safer than car travel. So why are so many of us afraid of airplanes? The answer can be described in terms of conditional probabilities. The probability of dying in an air fatality is the product of two different probabilities—the probability the airplane will crash, and the probability that, in the event of a crash, the passenger will die. The first probability is extremely low—virtually zero. The second probability is one (100%)—that the individual person will die if there is a crash—and that’s the probability that scares many people. But according to Bayes’s concept, the chance of mortality is a result of the product of these two variables—the chance of a crash, which is almost zero—times the chance of death. So, when the multiple is calculated—nearly zero times one—the answer remains almost zero. This very low conditional probability should provide much comfort to all air travelers.

Now let’s apply this same principle to the detection of mental disorders in our attempt to ward off mass firearm violence in schools, public gatherings, etc. According to the National Institute of Health, the prevalence of major mental illness in the U.S. is approximately 4.2% of the entire population, meaning that about 10.4 million people harbor serious mental disorders. During the past six years, there were 43 individuals responsible for mass firearm attacks. Even if one assumes that this entire group of 43 was mentally ill, which is unlikely, it would constitute an infinitesimally small percentage (.000004) of all those suffering from mental illness. Applying Bayes’ theorem, unless we had a fail-safe (100%) method of detecting individual would-be killers from this large group of mentally ill, our ability to find a likely killer remains at nearly zero, which represents the proverbial needle in the haystack. Moreover, all mental health professionals freely admit that it is virtually impossible to predict accurately which of those with known mental disorders will perform such acts of violence. Compounding this problem even further, laws in this nation generally preclude forced detention of mentally ill individuals who have not yet performed any act of violence. What this means is that, given these extremely daunting numbers, detection and treatment of those with suspected mental illness in the effort to ward off gun violence is a virtual impossibility, notwithstanding the pronouncements by many politicians.

It all boils down to a simple bottom line: Major efforts must be aimed primarily at sensibly limiting everyone—whether or not mentally ill—from obtaining firearms capable of mass destruction. Reverend Bayes, among many others, would be gratified!


Tavel, ME, “Snake Oil is Alive and Well: The Clash between Myths and Reality. “Reflections of a Physician”. Brighton Press, Inc. Chandler, Arizona, 2012


Good Fats and Bad Fats: Where do we Stand Now?

Most of you have by now heard recent media stories that claim to debunk long-established beliefs that saturated fats do not cause heart disease and that the vegetable oils that we’ve been encouraged to use instead may actually promote it.

But the best-established facts on dietary fats say otherwise. How well polyunsaturated vegetable oils hold up health-wise when matched against saturated fats like butter, beef fat, lard and even coconut oil depends on the quality, size and length of the studies and what foods are eaten when fewer saturated fats are consumed.

So before you succumb to wishful thinking that you can eat with abandon well-marbled steaks, pork ribs and full-fat dairy products, you’d be wise to consider the findings of what is probably the most comprehensive and untainted review of the dietary fat research yet published. It can be found in a 26-page advisory prepared for the American Heart Association and published last June by a team of experts led by Dr. Frank M. Sacks, professor of cardiovascular disease prevention at the Harvard School of Public Health. The report helps to explain why the decades-long campaign to curb cardiovascular disease by steering the American diet away from animal fats has been less successful than it might have been and how it inadvertently promoted expanding waistlines and an epidemic of Type 2 diabetes.

When people cut back on a particular nutrient, they usually replace it with something else to maintain their needed caloric input. Unfortunately, in too many cases, saturated fats — and fats in general — gave way to refined carbohydrates and sugars, the so-called SnackWell phenomenon that prompted fat-wary eaters to overindulge in high-calorie, low-nutrient foods. Most people do miss their unhealthy fats and, in the latest rage, many have latched onto coconut oil in the mistaken belief that its main highly saturated fat, lauric acid, and other nutrients can enhance health rather than undermine it.

As documented in the new advisory, misleading conclusions that saturated fats do not affect the risk of developing and dying from cardiovascular diseases have largely resulted from studies that failed to take into account what people who avoided saturated fats ate in their place. Several of the otherwise well-designed trials involved too few participants or did not last long enough to reach a scientifically valid conclusion. It can take up to a decade or longer to show that consuming healthier fats can produce a decline in cardiovascular deaths, and few well-controlled clinical trials last that long.

Some studies may have failed to show a benefit from reducing saturated fats because participants substituted margarine and other partially hydrogenated vegetable oils containing trans fats that were later shown to be even more damaging to blood vessels than animal fats. This was a problem in the Sydney Heart Study, conducted from 1968 to 1973; the experimental group was given margarine high in trans fats, resulting in more cardiovascular events than among those who continued to eat lots of saturated fats like butter.

On the other hand, the results of four “core” trials conducted in the 1960s, lowering saturated fat and replacing it with vegetable oil rich in polyunsaturated fat, primarily soybean oil free of trans fats, lowered coronary heart disease by 29 percent, similar to the benefit from taking a statin to reduce cholesterol.

In later studies, the most important influence on the results was the types of foods study participants ate in place of saturated and other fats. For example, in a study of 252 British men who had suffered heart attacks, following a low-fat, high-carbohydrate diet reduced cholesterol levels by a meager 5 percent and had virtually no effect on future heart attacks. The carbohydrates they ate were mainly refined, low-fiber flours and sugars that promote weight gain and diabetes, two leading risk factors for heart disease. In North America and Europe, the effect of lowering saturated fat was essentially negated by people’s consumption of more “refined grains, fruit juice, sweet desserts and snacks, sugar-sweetened beverages, and other foods” that hardly promote good health.

Unfortunately, there have been no trials to date testing the cardiovascular benefits of replacing dietary fat with “healthful nutrient-dense carbohydrates and fiber-rich foods such as whole grains, vegetables, fruits and legumes that are now recommended in dietary guidelines. The most recent studies conducted that analyzed the effects of specific nutrients showed that when 5 percent of calories from saturated fats were replaced by an equal number of calories from polyunsaturated fats, monounsaturated fats (like olive and canola oils) or whole-grain carbohydrates, the risk of coronary heart disease was reduced respectively by 25 percent, 15 percent and 9 percent. Furthermore, when polyunsaturates and monounsaturates replace saturated fats, death rates decline from cancer, dementia and lung diseases as well as from heart disease and stroke. In other words, if you are truly concerned about preserving good health overall, focus on a Mediterranean-style diet heavy on plant foods and unsaturated vegetable oils, with whole grains, fruits and vegetables as the main sources of carbohydrates.

Thus information stemming for the best research is straightforward: consume few saturated fats like butter, full-fat dairy, beef and pork fat, and coconut, palm and palm kernel oils and replace them with natural vegetable oils high in polyunsaturates — corn, soybean, safflower, sunflower, peanut, walnut and grapeseed oils. Also healthful are canola and olive oil, rich in both monounsaturates and polyunsaturates.

Based on the National Health and Nutrition Examination Survey, almost half the calories in the American diet come from carbohydrates, and of those 80 percent are from refined starches, sugar and potatoes. Sadly, the average American diet is not very healthy, to say the least.

Although dairy fat as not optimal, it is not nearly as good as plant fats, but not quite as bad as other animal fats. Thus you don’t have to totally abandon cheese, but dairy foods should be limited to one serving every one to three days, not thee servings a day.

As for coconut oil, it may be the nutritional fat du jour but it has not been proven to be healthful. It is fine to use on your body as a moisturizer for skin or hair, but not necessarily in your body, although consuming small amounts is unlikely to be harmful.

So here we are again back to square one, but now with with important qualifications as noted above!



This was the intriguing subject of an article by Dara Horn1 appearing recently in the New York Times. In it, Horn describes how several billionaires have sunk lots of money into projects called “life extension,” or “end aging forever.” These aspirants seem to be composed of mainly billionaire men, possibly owing to the likelihood that women would prefer not to be around with the likes of such man for such a lengthy period. These men seem to believe that interminable life does not “violate the laws of physics.” Ironically, they seem to have gained some support from a woman, Elizabeth Blackburn, who received the Nobel Prize for her work on telomeres, which are protein caps on chromosomes (cellular elements) that may be a key to understanding aging. But Professor Blackburn admits that her important research, while allowing for a better understanding of aging, does not suggest living to one’s hundreds, stating that “everyone’s cells become old and eventually we die,” which suggests that her research may allow a better chance for us all to live a long and healthy life.

But in the extraordinary unlikely event that eternal life could be achieved, what would be its practical implications? First, as suggested by the billionaires, it would extremely costly and likely limited to the very affluent, sowing the seeds of severe social unrest. As a result, those who possess limited resources would be left “out in the cold,” and likely and foolishly demand that immortality be covered by medical insurance. But suppose eternal life were to become cost-effective. This planet would then be overcrowded so severely that all resources would be exhausted and new births all but prohibited. The environment would take a severe drubbing with global warming, disastrous environmental desecration, inundating sea water levels, and insufferably high temperatures.

Then there is the matter of evolution: Human development, lacking generational replacements, would be halted, thus preventing us to from becoming a better and more adaptable species. (We could certainly use some betterment, at least in politics!) At the same time various animal species would presumably continue to evolve, and maybe some of our higher relatives might equal or pass us up, resulting in a planet of apes?—or dolphins?

So, as enticing as eternal life may seem to each of us, it is simply not to be, not now and not forever!

But now we get practical and examine the issue of present longevity.

This is also an even more intriguing subject, and while there are obviously no clear answers, it brings up two important questions: 1) How long would we survive if all presently known diseases were eradicated? 2) How far could science take us, provided we have emerged victorious over these diseases? So let’s look at each question separately.

Life Expectancy in the Absence of Disease

In 1900, average life expectancy in the USA was approximately 47 (women living about 2 years longer than men). By 1998, the average had risen to around 76 (women doing better by about 5 1/2 years. But note from the chart below that we made most of this progress between 1900 and around 1970. The early rapid progress was primarily attributable to our victory over infectious diseases, which was halted temporarily by a drop in mortality in 1918 resulting from the influenza epidemic (note in the chart) . Since 1970, the curves are rising more slowly because of the more formidable challenges than posed by the various non-infectious diseases.

Now our biggest killers are related to cardiovascular diseases, (heart disease and strokes) caused primarily to arteriosclerosis (hardening of the arteries), and cancers of all types. Based upon the numbers, if we could wipe out cardiovascular disease and cancer, we could allow most folks to live out a maximum number of years based upon our current understanding of human physiology.

Causes of Death in the USA in 2010

  • Heart disease: 597,689
  • Cancer: 574,743
  • Chronic lower respiratory diseases: 138,080
  • Stroke (cerebrovascular diseases): 129,476
  • Accidents (unintentional injuries): 120,859
  • Alzheimer’s disease: 83,494
  • Diabetes: 69,071
  • Kidney Diseases, nephrotic syndrome, and nephrosis: 50,476
  • Influenza and Pneumonia: 50,097
  • Intentional self-harm (suicide): 38,364

Based upon published information together with my medical knowledge, I believe that we could reach an average age of 100-110, provided that at least these two major disease categories, mentioned above, could be eliminated.

In the case of cardiovascular diseases, we have the answers now, provided that the various lifestyle problems and predisposing conditions could be corrected. They include improper diets, obesity, smoking, hypertension, lack of exercise, and others of lesser importance. It’s generally conceded that prevention offers a far more effective strategy than do medications and surgical procedures to reduce mortality. Thus treatments of all types are only of limited importance. A recently reported counter trend slight fall in lifespan is likely not indicative of a major trend shift, but if sustained, would be likely due to poor lifestyle choices, especially advancing obesity.

Cancer provides a formidable challenge, possibly because it is likely multi-factorial in cause and often extremely difficult to treat with our current methods. With advances in our understanding cell biology, including DNA makeup and manipulation, together with controlling immune reactions, we are likely to solve this riddle within the next few years—probably not soon enough in my judgment.

How Far Could Science Take Us Next?

The answer to this question takes us into the realm of science fiction, but, for what it is worth, here are my thoughts.

Despite the great advances in such areas as organ transplantation, cell mechanics, surgical procedures, and many others, I believe that the maximum life expectancy will remain capped in the area of 110. I say this because, as noted in the chart below, we are already beginning to level off, and despite many advances in organ transplantation and other potential treatments, various targeted methods and replacements cannot support the entire body, such as muscles, bone, brain and others. Thus the entire body continues the inexorable process of aging. For this reason, we are likely to be restricted by such limitations in lifespan as determined by evolution.

The assumptions stated above are merely that, but in order to advance beyond these limits we would need extreme and game changing advances that are not possible to foresee at this time. But who knows?

In the meantime, be careful what you wish for!

                      Violet line = Females.   Black line = Males.




1Horn D. The men who want to live forever. N.Y. Times, January 28, 22018. p. 9



You may have recently heard that drinking “raw water” is the latest health panacea. Advocates are claiming great health benefits to be derived from this source, among which are the elimination of that nasty fluoride, the acquisition of beneficial probiotic bacteria, and lord knows what else! And paying big money to boot! Their claims seem to fall in line with those zealots who are touting raw milk, an equally nutty claim that I have covered in a previous post: http://www.mortontavel.com/2013/12/03

Our municipal water is filtered for a reason. Untreated water may contain bacteria, viruses and parasites. Resulting health problems can range from mild gastrointestinal discomfort to diarrhea, dehydration and death. The bacteria that cause cholera, typhoid, dysentery and others can thrive in “natural” water, meaning raw water could provide a long trip to the toilet at best—and the hospital or morgue at worst. Water contains radon in many areas of the U.S., and 25,000 people die each year from radon exposure and consumption. Since raw water isn’t treated or tested, you may be ingesting potentially damaging levels of naturally occurring radon, as well as other unidentified chemicals and bacteria.

Proponents of raw water insist that their supply comes from pure springs that have no traces of diarrhea-inducing diseases, and they feel that the water’s natural probiotics and lack of fluoride outweigh the risk of contamination. But fluoride in water has never been found to be a risk to health, The Centers for Disease Control showed that tooth decay is down in the 70 years since routine fluoridation started. As for probiotics, it’s true that tap water filters out bad microbes like giardia, but also takes away less harmful bacteria that could be good for gut flora. Sadly, however, the probiotics in raw water won’t necessarily help fend off any diseases, and even though some research suggests that probiotics may be beneficial to health, one can obtain these microbes in a far safer fashion from products such as cultured yogurt.

I would simply conclude by asking a simple question: Would you be willing to drink raw water that might be no different from that attained from either a third-world country or your own toilet bowl? If so, go ahead at your own risk; in any event, your local hospital or funeral director will be more than willing to assist you.



They are all over the place, brazenly claiming to keep you revved up, energized, and alert. But controversy is now raging over these products, for several deaths have reportedly followed their use and more problems keep surfacing. So we need to explore the facts about these drinks.

First, how do they accomplish this energy infusion? I can answer with a single word—caffeine! We all know it is the active ingredient in coffee. An 8 ounce cup of coffee contains about 100 milligrams of caffeine. By contrast, a 16-ounce Starbucks Grande contains about 330 milligrams. That’s why most people drink coffee in the morning: It’s a helpful “waker-upper” to get them started and ready to attack the day with a head of steam.

Although caffeine can make you feel more alert, boost your mental and physical performance, and even elevate your mood, it can also make you jittery, keep you from sleeping, cause rapid pulse or abnormal heart rhythms, and raise blood pressure. Safe limits of caffeine consumption are still being studied, but data suggest that most healthy adults can safely consume up to 400 milligrams per day; pregnant women, up to 200 milligrams; and children, up to 45 to 85 milligrams depending on weight.

The content of caffeine in the various “energy” products is not always listed, but from what we know, caffeine content varies greatly, ranging from about 6 milligrams to as much as about 250 milligrams per serving.

Various scientific groups have for years urged the Food and Drug Administration to require disclosure of caffeine levels on these products, but the agency says it lacks the authority to do so. Also, some energy drinks include additional ingredients such as taurine, L-carnitine, and high amounts of B vitamins, such as niacin and vitamin B6, ingredients that are not of real benefit, but they may present additional problems.

Now comes more bad news about these drinks: More than half (55.4%) of young people who have ever consumed an energy drink have experienced at least one adverse reaction, according to a study published recently in a medical journal.
The research was conducted online among over 2,000 adolescents and young adults (age 12 – 24) in Canada. Most (73.8%) reported having ever consumed an energy drink, and, of these, 55.4% reported experiencing at least one adverse reaction. The most commonly reported reactions were rapid heartbeat (24.7%), difficulty sleeping (24.1%), headache (18.3%), nausea/vomiting/diarrhea (5.1%) and chest pain (3.6%). About 3% of respondents who suffered an adverse event had sought or considered seeking medical help for an adverse reaction. Those who reported having ever consumed an energy drink were almost three times more likely to report an adverse event than those who reported having ever consumed coffee. According to the authors, the current findings are consistent with those of Health Canada’s Expert Panel on Caffeinated Energy Drinks, which concluded that, although the probability of serious adverse events is low, given the high volume of use, the risk of adverse events is considered to be a public health issue.
Previously, a 2015 study published in the Journal of the American Medical Association concluded that drinking a single energy drink may increase cardiovascular risk, and the drinks have been associated with cases of brain hemorrhage, acute hepatitis, and vitamin B6 toxicity. Disconcertingly, a 2017 study published in Journal of Medical Toxicology found children under the age of six accounted for almost 45% of energy product exposures reported to poison control centers in the U.S.

Conclusion: My advice: Stick to coffee, considering the caffeine limits cited above. Forget the “energy drinks.” They are not only a waste of money but also a danger to health!




We physicians are often asked to conclude two things from a regular “checkup” of someone who has no symptoms to suggest present disease: 1) What is the likelihood that one is harboring an unrecognized but hidden disease? 2) What is the likelihood that disease will develop in the future?

In the absence of complaints, information from a physical exam seldom discloses unrecognized diseases, and routine laboratory screening tests seldom add much of additional value. Thus the results of Trump’s exam tell us very little about any present physical diseases, especially in the absence of psychological testing. But can his findings tell us anything about his chances of impending future health disasters? Based upon his lifestyle choices and family history, his greatest chances of future diseases are cardiovascular events (heart attacks, stroke, etc.) and dementia (Alzheimer’s disease).

With regard to cardiovascular risk (our largest killer by far), using the various charts supplied by the American Heart Association and others, which include age, sex, blood pressure, and certain blood tests, Trump’s chances of developing serious cardiovascular events within the next ten years are approximately 15%. At his age, less than 10% is considered reasonably low.

But additional factors must be added that include his coronary artery calcium score of 133 (on CT scans), a number that means he already has asymptomatic cardiac vascular disease.  The calcium score directly correlates with the risk of overt future cardiac events. People with higher scores have greater plaque burden on the linings of these arteries, carrying a higher risk for cardiac events regardless of whether symptoms are present. For asymptomatic individuals, a calcium score of 0 indicates absence of detected calcium and an extremely low likelihood (<1%) of any coronary arterial disease. The odds ratio (ratio of events in an interest group vs. events in a baseline population) of developing symptomatic cardiovascular disease is 3:1 for people with scores of 1 to 80 (where the zero score group is the baseline population), 8:1 for people with scores between 80 and 400 (Trump’s group) and nearly 25:1 for people with scores above 400. In fairness, Trump is taking “statin” drug and aspirin to minimize this risk, but, nevertheless, the dangers are clearly present.

What may be more damming, however, is Trump’s widely publicized poor diet with obesity (yes, folks, despite his denials, according to the published charts, he is obese), and lack of regular exercise, factors that, while difficult to quantify, when coupled with the presence of coronary calcium, would raise his overall odds of serious cardiovascular events to at least 20-30% over the next ten years (three years obviously being a substantial portion of this number). Obesity, per se, raises his odds significantly for developing various cancers: https://www.cancer.gov/about-cancer/causes-prevention/risk/obesity/.

But what if we add his chances of present mental disorder or future dementia? Based upon his family history (his father suffered from Alzheimer’s disease), it is entirely possible that Trump himself already is manifesting its early phases or, at least, has greater chances of developing dementia soon in comparison with the general population.  Despite Trump’s examining physician’s recent claim that his “cognitive ability” is normal, it is widely acknowledged that there is little correlation between cognition (intelligence) and insanity. This information, coupled with Trump’s erratic behavior, should mandate an immediate and comprehensive neuropsychiatric examination, which, sadly, is likely to be denied.

Does this information justify the declaration by the White House that Trump is in “excellent health”? For the present, maybe so, maybe not. But for the future, I’m taking no bets, and neither should you!



     For the past sixty plus years, we have known that exercise—in almost all forms—is beneficial to health. The European Guidelines on Cardiovascular Disease Prevention, the World Health Organization, and the Physical Activity Guidelines for Americans all recommend that healthy individuals engage in 150 minutes per week of moderate intensity exercise, such as brisk walking, or 75 minutes of high intensity exercise, such as jogging. But recent research has also hinted that there may be added benefit from pushing yourself intermittently, at least a little extra, bringing about changes deep within our body’s cells—those tiny building blocks that constitute all of us. Exemplifying this idea is the case of Robert Marchand, a diminutive French centenarian who took up competitive cycling as a retiree and began setting age-group records. After he was advised to add intermittent strenuous pedaling, Mr. Marchand decisively bettered his own records and, at the age of 103, set a new world mark for the most miles pedaled in an hour by a centenarian.

His efforts help to refute entrenched beliefs about older people, that physical performance and aerobic capacity inevitably decline with age and that intense exercise is inadvisable and does not apply to the elderly.

For instance, one study disclosed that frail elderly mice were capable of completing high-intensity running on little treadmills. After four months of this kind of training, the exercised animals were stronger and more aerobically fit than other mice of the same age, especially if that exercise was supplemented with high-intensity interval training.

Extending these observations to people, scientists at the Mayo Clinic compared differences in gene expression inside muscle cells after younger and older people had completed various types of workouts. The greatest differences were seen in the operations of genes after people had practiced high-intensity interval training for 12 weeks. In younger people who exercised this way, almost 275 genes were firing differently now than they had been before the exercise. But in people older than 64, more than 400 genes were working differently now and many of those genes are known to be related to the health and aging of cells. In effect, the intense exercise seemed to be changing muscle cells in ways that theoretically could affect biological aging.

At this point, I should probably pause and explain that intensity in exercise is a relative concept. The word intense can seem daunting, but in practice, it simply means physical activity that is not a cinch for you.

For medical purposes, intensity is based on percentages of someone’s heart rate maximum. But you can ignore these technicalities and pay attention to how you feel. Exercise is easy if you can talk and sing while participating in it.

During relatively moderate exercise, singing becomes difficult.

And during intense exercise, you will find it difficult to speak without gasping.

We all should get regular exercise, but no matter what your routine, you might consider increasing its pace for a few minutes at a time, until you no longer can easily converse. The latest science suggests that your cells will thank you.

But as always, the most compelling exercise-related research this year reminds us that activity of any kind is essential for human well-being. One study of 2017 found that people reported feeling happiest during the day when they had been up and moving compared to when they had remained seated and still. The benefits of exercise extend even to those suffering from various degrees of depression, providing with another means to combat this malady.

Another memorable study concluded that, statistically, an hour spent running could add about seven hours to our life spans. These gains are not infinite. They seem to be capped at about three years of added life for people who run regularly.

But these results should inspire all of us. If Mr. Marchand can gain fitness and speed after turning 100, that should be incentive to all of us with still a half-century or more to spare.

And even if we don’t succeed in adding years to our lives, we can at least add life to our years!


Assessing Presidential Fitness: Thoughts that have come 230 years too late—but better than never!

Several weeks after former President Ronald Reagan announced his Alzheimer disease diagnosis in 1994, his predecessor, Jimmy Carter, appealed to the medical community. But Carter, the 39th president of the United States, didn’t urge physicians to take up a fight against this neurodegenerative disease. Instead, Carter attempted to tackle presidential disability and the 25th Amendment of the US Constitution.

In a published commentary, Carter contended that Section 4 of the amendment—a mechanism that allows the vice president and a majority of Cabinet members to pronounce a president “unable to discharge the powers and duties of his office”—is inadequate. They would need accurate, unbiased medical advice from qualified physicians, Carter wrote. It would require those physicians to delicately balance patient confidentiality, personal interest, and the country’s well-being.

“We must find a better way,” he stated.

His suggestion: create a nonpartisan group of medical experts not directly involved in the president’s care to determine presidential disability. Twenty-three years later, Carter’s proposal hasn’t come to fruition. But it’s no longer lying dormant.

Rep Jamie Raskin (D, Maryland) introduced a House bill in April to create an 11-member “presidential capacity” commission composed of psychiatrists, other physicians, and retired government officials selected by leaders in Congress. “Now is the time to do it,” Raskin said in a statement.

In a recent bestselling book, 2 practicing psychiatrists offered an alternative proposal, recommending that a 7-member expert panel be established to evaluate presidential fitness.

During an interview with JAMA, a leading medical journal, one of these psychiatrists discussed the issue of presidents’—past and present—fitness to serve. An edited version of that conversation follows.

Question: Why did you decide to wade into the territory of presidential fitness?

Answer:  President Trump’s mental status engendered controversy among our colleagues because of the Goldwater rule. During Barry Goldwater’s run for president in 1964, a magazine polled about 1100 psychiatrists who rendered opinions about his mental fitness without seeing him for an evaluation. Afterward, Goldwater sued the magazine for libel and won. As a result, the American Psychiatric Association instituted the Goldwater Rule, which prohibits psychiatrists from diagnosing an individual without a face-to-face evaluation. When mental health professionals began to raise concerns about President Trump’s mental stability, the APA added a further proscription against offering any opinion about his mental health. In April, Dr Bandy Lee (assistant clinical professor in the Law and Psychiatry Division, Yale School of Medicine) chaired a conference at Yale to discuss psychiatrists’ “duty to warn.”

Question: What is duty to warn, and could you explain how the concept came about?

Psychiatrist’s answer: This obligation is derived from the landmark [Tarasoff v Regents of the University of California] decision by the California Supreme Court in 1976. It states that if patients disclose to their therapist that they intend to injure specific individuals, the therapist has a duty to warn those individuals. The Tarasoff decision ultimately created a legal duty to protect that overrode the confidentiality of the patient-therapist relationship. This duty was subsequently adopted in other states in various forms and has become a standard of mental health practice.

Question: To what other US presidents would a presidential fitness commission have been applicable?

Answer: A review of US Presidents from 1776 to 1974 found that 49% of those 37 presidents met criteria that suggest neuropsychiatric disorders. For example, Presidents Franklin Pierce and Abraham Lincoln had symptoms of depression; Nixon and Johnson, paranoia; and Reagan, dementia. President Woodrow Wilson suffered a massive stroke in office that resulted in severe cognitive impairments. Although military personnel who are charged with relaying and executing nuclear orders from the president must undergo rigorous medical, psychological, and financial evaluations to determine their fitness for duty, no such evaluation is necessary for their commander-in-chief. We feel that this glaring omission can be remedied.

Question: What is the remedy?

Answer: The 25th Amendment to the Constitution addresses presidential disability and succession. Section Four of this amendment has never been invoked to evaluate whether a president is fit to serve. We exhort Congress to use this section of the 25th Amendment to impanel an independent, impartial group of experts to evaluate whether the current and future presidents and vice presidents are mentally fit to fulfill the duties of office.

Question: Who would serve on such a panel and how would the members be chosen?

Answer: The panel should consist of 3 psychiatrists—1 clinical, 1 academic, and 1 military; 1 clinical psychologist; 1 neurologist; and 2 internists. Panel members should be nominated by the nonpartisan, nongovernmental National Academy of Medicine. The experts should serve 6-year terms with the provision that 1 member per year be rotated off and replaced. Congress should enact legislation to authorize this panel to perform comprehensive mental health and medical evaluations of the president and vice president on an annual basis. The legislation should require the panel to evaluate all future presidential and vice presidential candidates. The panel should also be empowered to conduct emergency evaluations should there be an acute change in the mental or physical health of the president or vice president. The evaluation should be strictly confidential unless the panel determines that the mental health or medical condition of the president or vice president renders him or her incapable of fulfilling the duties of office. We feel that this process should be initiated immediately.

Question: How did you decide on the types of experts that should be on the panel?

Answer: Psychiatrists would be able to evaluate someone’s mental status and diagnose any significant mental disorders and also to evaluate for potential dangerousness. The clinical psychologist is usually a specialist in psychological testing, and a neurologist could help evaluate cognitive and brain functioning. Of course, internists would look at the general medical status of the person. We figured that would cover all the bases that we would need to be concerned about.

Question: Why did you want to have a military panel member?

Answer: We thought it would be fair to have someone who may have a better sense of the kinds of situations that a president would face in terms of handling the nuclear arsenal.

Question: Would nominations to the panel require approval by Congress or some other body?

Answer: Since this is brand new territory, I suspect that it would be incumbent upon the Congress to impanel this group of professionals. But I think it could be difficult, so in my opinion, it would be better if Congress would rely on the National Academy of Medicine to come up with these experts. You want it as nonpartisan as possible.

Question: You’ve shared your ideas with President Obama and some members of Congress. Did you consider that part of your duty to warn?

Answer: Yes. We believe that we have a higher duty to warn if we feel that the US president presents a danger to others—others being this country and the world.


From a medical perspective, I believe these suggestions are quite reasonable and should be implemented quickly. In today’s toxic political environment, however, this may be a pipe dream. But, nevertheless, it could at least serve to identify those voting against such a plan as certifiably insane and legitimate candidates for the loony house! Now which party do you suppose could comprise the lion’s share of those “no” votes?






 Since 2010, the flu has resulted in about 500,000 hospitalizations yearly and contributed to about 25,000 deaths. That’s why the CDC (Centers for Disease Control) urges everyone 6 months and older to get vaccinated. But a recent survey disclosed that only 48% of adults said they had received a flu shot in the previous 12 months.

One reason for not receiving this valuable protection is based on the premise that the shot “doesn’t work,” but actual research indicates that the shot cuts your risk by about 50% or more. And even if you contract the flu, the symptoms will be mitigated with a reduced likelihood of serious complications—including death!

Another reason frequently given is that the shot may actually cause the flu. However, all the flu vaccines in use today contain an inactivated virus that can’t trigger the flu. But since the vaccine doesn’t eliminate entirely your chance of getting the flu, some people who develop flu-like symptoms after getting the shot wrongly blame the vaccine, or might be suffering from a condition that only mimics the flu.

Another excuse I hear for not getting the shot is that is contains a harmful amount of mercury. But this is a mercury-containing preservative called thimerosal found in some vaccines, but if present, only in trace amounts. This kind of mercury—ethylmercury—is eliminated by the body more quickly than is methylmercury, the form in some seafood. Moreover, no research has ever linked this substance to any complications, including autism.


    For teens and adults: a quadrivalent vaccine is recommended, which protects against four flu strains.

For people 50 and older: Flublok Quadrivalent, which has triple the dose of other quadrivalents.

For people 65 and older: They have two choices—Fluzone High-Dose and Fluad. Both protect against three strains, but Fluzone has four times the dose and Fluad adds an ingredient to boost the immune system’s response, a property that leads me to recommend this latter choice.

Under all circumstances, do not fail to consider this protection, which can be obtained from you doctor, but also quickly and easily in many pharmacies such as Walgreen’s and CVS.



Soon after her husband died of colon cancer in 1998, Katie Couric, the journalist and television personality had a televised colonoscopy to promote the test. Rates of screening colonoscopies soared for at least a year. Or, call it the “Angelina Jolie effect”. In 2013, the actress wrote an editorial in the New York Times about the tests she had for genes (called BRCA) linked with breast and ovarian cancer, and how the positive result led her to have a double mastectomy. Soon after, rates of BRCA testing jumped.

Whatever you call it, the effect is real. When it comes to matters of health, celebrities can have an enormous impact.

It’s good when celebrities do good

The impulse to take a challenging or tragic medical experience and turn it into something that helps others is commendable. It may be easier to keep such matters private or avoid talking about them in public. But time and again, we see celebrities joining forces with health-promoting organizations, speaking out, and sharing their stories to help others in making decisions. Many have credited Katie Couric with removing the embarrassment associated with colonoscopy and showing how apparently easy it is.

But there is a downside

There are a number of ways celebrity pronouncements on matters of health can go wrong. For example, the information can be faulty or confusing. The forays of Jenny McCarthy (who claimed vaccines cause autism) and Gwyneth Paltrow (who recommended vaginal steams to “cleanse the uterus”) into matters of health and illness are examples of influence most doctors would consider unhelpful or even dangerous.

Although Katie Couric’s colonoscopy experience seemed like a brave and unique way to get her message across, she was 43 years old at the time. Since guidelines suggest people begin routine screening at age 50, she was actually not a good candidate for the test. Unless she had symptoms (such as intestinal bleeding), a strong family history of early colon cancer, or some other special circumstance that put her at higher than average risk for colon cancer, her colonoscopy could be considered unnecessary testing. And that could have led others to have unnecessary testing as well.

A recent study raises a similar concern about Angelina Jolie’s BRCA testing. It found that in the weeks after her editorial was published, testing increased by more than 60% (at an estimated cost of $13.5 million). However, mastectomy rates actually fell over the next two to six months, leading the authors to suggest that most of the additional women who had testing had negative results and therefore may have been poor candidates for testing in the first place. Of note, the study did not confirm whether those having the BRCA test had risk factors (especially a family history of early breast or ovarian cancer) that would make the test appropriate. Critics of the study have suggested that mastectomy rates within six months of testing is not an adequate measure of whether the tests were appropriate. Still, the point is worth considering. When a celebrity recommends a medical test or treatment, the audience is not limited to those who are most likely to benefit.

But this is only a small sample of so much mischief reverberating in our media. Both Dr. Mehmet Oz and Dr. Travis Stork and his co-hosts (The Doctors) are licensed physicians (celebrities?), but despite their credentials, seem to be willing to dispense unproven, false or misleading information. Many other so-called “authorities” lack even these credentials and, as you might anticipate, they dole out copious misinformation to an unsuspecting—and often uncritical—public. One example (of many) concerning Ozy was a charge brought by the U.S.  Federal Trade Commission (FTC) that he was involved in a scam to deceive consumers through fake news sites and bogus weight loss claims: Oz had touted the use of the dietary supplement Pure Green Coffee as a potent weight loss treatment that supposedly burns fat. He claimed falsely that users of this product could lose 20 pounds in four weeks, 16% of body fat in 12 weeks, and 30 pounds and four-to-six inches of belly fat in 3 to 5 months. Sounds too good to be true—yes it was! According to representatives of the FTC, “Not only did these defendants trick consumers with their phony weight loss claims, they also compounded the deception by advertising on pretended news sites.”

The bottom line

For any medical test or treatment, ask whether it’s likely to be helpful. The answer may be straightforward. For example, a well-studied and well-accepted screening test may be recommended based only on your age and gender. But in many cases, the answer may rely on a considerable amount of judgment based on how likely it is that you have—or may develop—a particular condition, the ability of the test to detect it, and the impact of the test result on treatment decisions. For example, if a person has knee pain that’s mild and well-controlled with exercises, it may make little sense to have an MRI, as the results are highly unlikely to affect treatment.

If your doctor recommends a test or treatment, make sure you understand why. And if it’s a celebrity making the recommendation, do yourself a favor: run it by your own doctor—and not the TV variety!



y http://www.mortontavel.com/2014/05/28/