Data from a California study published today in the November 4 issue of the Journal of the American Medical Association have revealed that Swine Flu kills more than 1 in 10 of those it affects severely enough to put in a hospital. The study, conducted by the California Department of Public Health investigated H1N1 flu cases in California between April 23 and August 11, 2009, including fatality and other clinical features. The authors found that the overall fatality associated with H1N1 flu in California was 11 percent and was highest (18 percent – 20 percent) in persons aged 50 years or older.
For those affected severely by the H1N1 virus, it appears that the most common cause of death has been Pneumonia and Acute Respiratory Distress Syndrome, occurring within twelve days of onset of flu symptoms. These findings are supported by the World Health Organization’s report on The Clinical Features of Severe Cases of Pandemic Influenza. According to WHO, Primary viral pneumonia is the most common finding in severe cases and a frequent cause of death. Secondary bacterial infections have been found in approximately 30% of fatal cases, and Respiratory failure and refractory shock have also been the most common causes of death.
The message to take home from this latest study is that overall, severe symptoms of the H1N1 infection appear to be occurring across all age groups with the highest fatality rates being among those over age 50, contrary to the common perception that H1N1 flu affects mostly young people. Additionally, both the JAMA study and WHO findings suggest that obesity, and especially morbid obesity, have been present in a large portion of severe and fatal cases of the virus, although the exact role of obesity is not well understood at present.
For more information on distinguishing the clinical features of a severe H1N1 infection, please refer to the following report: WHO – Clinical features of severe cases of pandemic influenza
We have all heard the slogan, “Early detection is the best protection.” As a matter of fact, as a health professional, I find that I can seldom sort through my weekly medical mail without having that slogan staring at me from nearly a dozen different postcards and other mail received from a myriad of local health facilities and hospitals. Notwithstanding that, in this post, I challenge conventional wisdom vis-à-vis this slogan, and ask you to consider another crucially important perspective on this matter.
If you are a woman and concerned about becoming a victim of breast cancer, your doctor might advise you to get regular mammograms for the purpose of “early detection.” Similarly, if you are a man, and are concerned about prostate cancer, your doctor may ask you to get a “PSA” or Prostate-Specific Antigen test. While “early detection” as represented by these tests is valuable and important, and does indeed save lives from the standpoint of early treatment, it does nothing to prevent anything; that is, you cannot prevent breast or prostate cancer by early detection! If you “detect” cancer or even pre-cancerous changes in the body’s tissues, it clearly means that either the cancer, or the pre-cancerous condition, has already occurred. In other words, you are now obligated to address a problem that has already manifested itself; you have not prevented it in the first place. Here is my perspective in this matter — I believe that True Prevention can and should occur long before the possibility of disease detection, and a really solid nutrition and lifestyle-based prevention plan might help us make the actual detection of a good percentage of certain cancers irrelevant by putting the effort and emphasis on pro-actively and aggressively preventing these cancers from occurring in the first place.
Now, before you tell me that not all chronic diseases such as certain cancers are preventable, I must interject by asserting that a significant percentage of cancers are in fact preventable. Research suggests unequivocally that only 5-10% of all cancer cases can be attributed to genetic defects, whereas the remaining 90-95% have their roots in an individual’s environment and lifestyle (1). Here is the official breakdown of known factors linked to cancer for all cancer-related deaths:
- Almost 25-30% are due to tobacco use
- As many as 30-35% are linked to diet
- About 15-20% are due to infections
- The remaining percentage is due to other factors such as carcinogenic exposures, stress, lack of physical activity, environmental pollutants, etc, i.e. “environmental factors.”
Research also suggests unequivocally that cancer prevention requires:
- Smoking cessation
- Increased ingestion of fruits and vegetables
- Moderate or no use of alcohol
- Caloric control
- Minimal meat consumption
- Whole grain consumption
- Avoidance of direct sun exposure
- Regular physical activity
- Prudent use of vaccinations as needed
The bottom line? We can no longer say that we have no control whatsoever over preventing cancer. The vast majority of cancers are in fact preventable, but they do require major lifestyle changes for most individuals. Two critical factors, that have been studied very extensively through research, give support to the preventability of cancer:
1. The link between diet and cancer is revealed by large variations in the rates of specific cancers in various countries, and the changes observed in the incidence of cancer among those who migrate. For example: Asians have been shown to have a 25 times lower risk of prostate cancer and a ten times lower risk of breast cancer than do residents of Western countries, and the rates of these cancers increase substantially after Asians migrate to the West (2).
2. Extensive studies with identical twins have suggested that genes are not the source of most chronic illnesses. For example, the concordance between identical twins for breast cancer has been found to be only 20% (3). Data suggest that instead of our genes, our lifestyle and environment account for 90-95% of most chronic illnesses.
The reality is this – The weight of scientific evidence that has emerged especially in the last two to three decades from academic centers globally has convincingly and unequivocally established the potent link between nutritional/behavioral choices and good health. Given this evidence, it would be folly, in fact even fatal, for us to ignore what True Prevention-based efforts can do for us. Dr. Walter Willett, Professor of Nutrition at The Harvard School of Public Health recently stated, “With careful attention to the foods we eat, combined with not smoking and regular physical activity, we find that over 80% of heart attacks and greater than 70% of certain cancers can be avoided (4).” From this statement, it seems reasonable to conclude that while we may not be able to wipe out all of cancer with the strategy of True Prevention, we ought to wipe out the 70% or more of cancer that we can, and so also obviate the 80% of heart attacks that are preventable.
The concept of pro-actively preventing deadly diseases such as certain cancers is not an idealistic fantasy. Statistics suggest that every 13 minutes, a woman dies from breast cancer, and increasingly, we are seeing cancer (such as that of the breast) occur in younger women. In light of these facts, we need to take a much more pro-active stance in preventing this disease to the maximum extent possible. Instead, I find that here in the West, too many of us have resigned either to doing our best to detect cancer “early,” or simply to wait for the “Magic Bullet” that will one day wipe out cancer. The point is that while it is incumbent upon us to continue to “race for the cure,” is it sensible not to put to good use the volumes of scientific data that clearly suggests that several common cancers can be prevented through diligent lifestyle modifications? I believe that failing to incorporate research- and evidence-based nutritional and lifestyle modifications as early as possible in life is tantamount to adopting a “reactive” rather than a “pro-active” stance towards this formidable disease, that may result in the death of millions.
In light of the above, I strongly believe that early nutritional and lifestyle interventions (and not early detection alone), coupled with educational initiatives to build awareness of environmental and other carcinogenic exposures, are the true keys to eventually winning the battle against deadly chronic diseases such as cancer. And, while admittedly these interventions may not help us conquer all of cancer, they can decidedly help us conquer a very significant percentage of it. I also believe that while early detection is advisable and should continue in order to help us save the lives of those who may have already become the unfortunate victims of a cancer, or a pre-cancerous condition, we should bear in mind that we are never going to prevent new cases of cancer from emerging if we don’t also get serious about True Prevention. I believe that reassuring millions that “early detection is the best protection” is tantamount to giving these individuals a false sense of security that they are doing “their best” to protect themselves, whereas in reality early detection cannot prevent cancer at all – it can only help us treat cancer as early as possible once the cancer or pre-cancerous conditions have already become existent. Thus, our best efforts to truly protect ourselves from cancer call for a lot more than early detection; they call for early prevention.
This year, more than 1 million Americans, and more than 10 million people worldwide, are expected to be diagnosed with cancer. This disease continues to be a worldwide killer and accounts for about 23% of total deaths in the U.S., being the second most common cause of death after heart disease, and in 2010 it is expected to rise to the rank of the first most common cause of death. Given these numbers, it is past time for us to be encouraged not just to detect cancer(s) early, but to learn all we can and do all we can to prevent cancer(s) from occurring in the first place – at least to the maximum extent possible.
There will always be – and should always be – an important emphasis on catching any disease early. However, the point of this post is this: Given the vast and increasing reach of cancer even in the face of decades of diligent research, it is simply not enough anymore for us to “detect” or “catch” it early. While we must do that, we must simultaneously also work committedly at preventing it early. Perhaps, it is best put this way: Early, committed and diligent efforts to prevent cancer coupled with early detection – are a better strategy than early detection alone. Conventional doctors are in a position truly to guide and encourage their patients to understand this reality and to help them pro-actively prevent cancer to the greatest extent possible. Whether we are academics, physicians, or lay individuals, it’s time to embrace a mindset and a culture of True Prevention. Indeed, doing so and catching the spirit of this idea will involve a revolutionary change in how we approach the treatment of chronic diseases, especially cancer. I dedicate this post to that end.
Notes
(1) Anand, et al. Cancer is a Preventable Disease that Requires Major Lifestyle Changes. Pharm Res. 2008; September 25 (9): 2097-2116.
(2) Food, Nutrition, Physical Activity and the Prevention of Cancer; Diet and Cancer Report
(3) A.S. Hamilton and T.M. Mack. Puberty and Genetic Susceptibility to Breast Cancer in a Case-Control Study in Twins. New England Journal of Medicine 348: 2313-22 (2003)
(4) Third Annual Great Issues in Medicine and Global Health Symposium, 2006. Linking our Food Choices to Cancer Risk, Dartmouth Hitchcock Medical Center.
RESOURCES
Anand et al. Cancer is a Preventable Disease that Requires Major Lifestyle Changes. Cytokine Research Laboratory, Dept. of Experimental Therapeutics, The University of Texas M.D. Anderson Cancer Center.
October is Breast Cancer Awareness Month, and while it is critically important to raise awareness of breast cancer prevention in general; it is also a particularly important time for us ALL – whether we are physicians, research scientists, women, or men – to become acutely aware of a relatively rare, but all too often, poorly understood cancer known as Inflammatory Breast Cancer, or IBC.
WHY TALK ABOUT IBC, IF IT IS INDEED RARE?
The answer of course, is simple. First, every life matters, and education and awareness saves lives. And, second, precisely because IBC is relatively rare (It accounts for 1 to 5% of all breast cancer cases in the US (1)), it is frequently not “caught” early by patients, and is further often misdiagnosed or even completely missed by physicians. The delay caused in obtaining prompt and necessary treatment by the combination of these two factors is simply too costly, as this disease progresses rapidly and can become lethal in a very short period of time.
GETTING THE FACTS
IBC is a type of breast cancer in which cancer cells block the lymph vessels in the skin of the breast. This cancer is referred to as “Inflammatory” because the breast can look externally swollen, red or inflamed. One of the main reasons why this cancer often goes undiagnosed is because women relate only the presence of a “lump” to breast cancer. However, it is crucially important for all women (and even some physicians) to know that a breast lump is NOT a necessary pre-condition for breast cancer, and this is especially true in the case of IBC. Generally, IBC tends to grow in “nests” or “sheets” rather than as a solid tumor. Here are additional symptoms that are typical of IBC:
- An unexpected pink, red or dark colored area on the breast, usually accompanied with itching or discomfort.
- Swelling of the breast, often up to a cup size or more very rapidly.
- Thickening of breast tissue or ridges on the skin
- Retraction of the nipple
- Discharge from the nipple – may or may not be bloody
- Sharp or stabbing pains in the breast, or a perceptible ache in the breast area
- Breast may feel warm to touch
- Alteration in color or texture of the areola (area surrounding the nipple)
- Swollen lymph nodes under the arm or above the collar bone (or in BOTH places)
The median age at time of diagnosis of IBC is 56 years, relative to about 62 years for non-IBC breast cancer.
LEARNING MORE ABOUT IBC DIAGNOSIS
The presence of IBC is confirmed by clinical examination, usually a biopsy, mammogram, and ultrasound. IBC is generally diagnosed as Stage IIIB or Stage IV breast cancer. Stage IIIB refers to cancer that is locally advanced, and Stage IV refers to cancer that has metastasized to other organs of the body. The resources provided at the bottom of this post are valuable for learning more on IBC Staging.
TREATMENT
IBC treatment generally consists of chemotherapy, surgery, radiation, and hormonal therapy. Chemotherapy with anti-cancer drugs is generally the first line of treatment for most patients with IBC (It is often referred to as Neoadjuvant therapy). Post-chemotherapy, patients may undergo surgery or radiation therapy to the chest wall. Additionally, IBC patients may receive more treatments (such as additional chemo- or hormone-therapy) to help prevent cancer recurrence. Hormonal therapy is generally geared to reduce the effects of the hormone estrogen that can promote cancer growth.
IBC PROGNOSIS
As IBC is more likely to have metastasized (that is, spread to other parts of the body) at the time of diagnosis, relative to non-IBC cases (2), the 5-year survival rate for IBC patients is generally between 25 and 50%. These figures are significantly lower than the survival rates for patients with non-IBC breast cancer. However, as with all statistics, average survival figures cannot be applied to predicting the prognosis for any particular individual.
CURRENT RESEARCH AND NEW TREATMENT PROSPECTS
IBC has only recently been recognized as a unique and genetically distinct form of breast cancer (3). Recently, scientists from the The Cancer Institute at NYU Langone Medical Center identified a key gene—eIF4G1—that is over expressed in the majority of cases of IBC, allowing cells to form highly mobile clusters that are responsible for the rapid metastasis that makes IBC an effective killer. It is anticipated that this finding will lead to the identification of new approaches, therapies and a new class of drugs to target and treat IBC. This may be a promising development as IBC generally responds poorly to chemotherapy, radiation, and other current treatments for breast cancer.
PREVENTING TRAGEDIES & UNDERSTANDING THE CRITICALLY IMPORTANT ROLE OF EDUCATION AND AWARENESS
Perhaps the most unfortunate tragedy associated with IBC is that the absence of a typical “lump” in the breast causes this cancer to be frequently misdiagnosed and misclassified. Due to the fact that IBC symptoms are often erroneously mistaken for an infection, physicians tend to prescribe antibiotics to patients – which results in unintentional, but a potentially fatal delay in treatment. Due to the fact that IBC is an extremely aggressive cancer, it can often cause death within 18 to 24 months of diagnosis.
WHAT YOU CAN DO: EDUCATE YOURSELF AND OTHERS ABOUT IBC
Here are some simple action steps you can take to help increase awareness of IBC, and promote education about this deadly cancer:
1. If this is the first time you have read or learnt about IBC, please recognize that there are numerous others for whom knowledge of this disease would be new as well. Please pass on this post to ALL those it may benefit.
2. Utilize the selected important resource links at the end of this post to learn more about IBC. Share these links with others as well.
3. This post will be made available at The Prevention Revolution on Facebook. If you have a question you may want to discuss or share an important comment, please join us on that site.
4. Finally, help us SAVE LIVES by joining the cause of EDUCATION OF INFLAMMATORY BREAST CANCER. Consider inviting your friends and family to support this effort.
Together, we CAN and SHOULD do more to stop this deadly killer.
NOTES
1. Merajver SD, Sabel MS. Inflammatory breast cancer. In: Harris JR, Lippman ME, Morrow M, Osborne CK, editors. Diseases of the Breast. 3rd ed. Philadelphia: Lippincott Williams and Wilkins, 2004.
2. Chittoor SR, Swain SM. Locally advanced breast cancer: Role of medical oncology. In: Bland KI, Copeland EM, editors. The Breast: Comprehensive Management of Benign and Malignant Diseases. Vol. 2. 2nd ed. Philadelphia: W.B. Saunders Company, 1998.
3. Key gene in deadly breast cancer identified (Science Daily – June 2009)
IBC RESOURCES
IBC Q & A – National Cancer Institute
MD Anderson IBC Page and Important Links
Information on IBC Clinical Trials - Click on Stage IIIB Clinical Trials
IBC – Clinical progress and the main problems that must be addressed (Full Text Access)
The IBC Support Mailing List Site
THIS ARTICLE PUBLISHED TUESDAY, OCT 12, ON GOOGLE NEWS TOP STORIES OF THE DAY, USA TODAY, BASIL AND SPICE.COM, THE GEORGIA STATE DEPARTMENT DIVISION OF PUBLIC HEALTH SITE, FLORIDA TODAY, ALLTOP.COM, AND NUMEROUS OTHER ONLINE NEWS SITES.
As of last Friday, October 9, 2009, a total of 76 H1N1-associated pediatric deaths in the U.S. were confirmed by the Centers for Disease Control and Prevention (CDC). Over the last three years, deaths among children from the regular seasonal flu have ranged from 46 to 88. Given that it is yet only early October, the loss of 76 children due to the H1N1 virus raises significant concerns for their protection and safety. In this post, I address some important facts relevant to the care of children who may be at a higher than average risk for an H1N1-related complication, and also reiterate prevention guidelines that may be of benefit both to physicians and others taking care of such children.
DEFINING WHICH CHILDREN ARE AT A PARTICULARLY HIGH RISK FOR FLU-RELATED COMPLICATIONS:
1. It is well known that children younger than 5 years of age, and those who have high-risk medical conditions are at an increased risk of Influenza related complications. Children at higher risk include all children with immune supression, chronic kidney disease, diabetes, asthma, heart disease, sickle-cell disease, or other problems related to the lungs.
2. In addition to the above, children with any condition that affects respiratory function including neurological conditions such as intellectual and developmental disability, cerebral palsy, spinal cord injuries, seizure disorders, metabolic conditions or other neuromuscular disorders have higher risk.
3. Finally, children with poor nutritional and fluid intake because of prolonged vomiting and diarrhea, and children with an underlying metabolic disorder such as Medium-Chain Acyl-CoA Dehydrogenase (MCAD) Deficiency – are more susceptible to both the seasonal flu- and the H1N1 flu related complications.
It is particularly important that parents, caregivers, and physicians stay on the alert for worsening disease symptoms in ALL children, but particularly in high-risk children. In addition to the expected symptoms of H1N1 (fever, sore throat, cough, etc.), if new symptoms appear in sick children, such as apnea, dehydration, recurring infection, an altered mental state, or extreme irritability - any of these should be a signal to immediately take more aggressive steps to prevent the situation from getting worse. Children experiencing any one or more of the above mentioned conditions should be under continuous expert care.
CONCERNS ABOUT CONTRACTING PNEUMONIA
One of the main concerns that is relevant both for adults and children is the fact that oftentimes during serious flu outbreaks, bacterial pneumonia infections can also become widespread. Generally speaking, Influenza predisposes people to community-acquired bacterial pneumonia, and can often be an important related cause of illness and death. Because of this fact, CDC’s Advisory Committee on Immunization Practices recommends the following:
- A single dose of PPSV23 (pneumococcal polysaccharide vaccine) for all people 65 years and older, and for persons 2 to 64 years of age with certain high risk conditions. This is due to the fact that people in these groups are at an increased risk of pneumococcal disease as well as serious complications from influenza (both seasonal and the H1N1).
- PCV7 (pneumococcal conjugate vaccine) is recommended for children aged less than 5 years.
COMMON SENSE RULES APPLY
In nearly all cases involving efforts to prevent an H1N1 infection (whether in adults or children), common sense rules must apply – many of which have been stated in previous posts. Further, keeping well-informed with respect to the types of drugs available, as well as their side-effects is also equally important. As the H1N1 Flu is an emerging disease, it become particularly critical for us to observe its course carefully, and to stay soundly informed as well as equipped with up-to-date information. It is quite clear that children are particularly vulnerable to the H1N1 virus; For this reason, it is incumbent upon us to minimize the tragic loss of life in this population by becoming as well-informed as possible with respect to their protection. To that end, please refer to some critical precautions presented in previous posts (links above) and take advantage of the important resources provided at the end of this one.
RESOURCES:
THE FOLLOWING ARTICLE WAS PUBLISHED THIS MORNING, OCT 6, ON GOOGLE NEWS TOP STORIES, USA TODAY, ASK NEWS, BASIL AND SPICE.COM, THE SUN-TIMES NEWS GROUP, AND OTHER ONLINE NEWS SITES AS “H1N1: Flu Widespread, 60 Children Dead (11 Last Week).”
The Centers for Disease Control announced last week that it had received reports of 60 deaths of children related to the H1N1 flu since April of this year; and 11 of these deaths have occurred within the last week. Further, between the period from August 30 to September 27, CDC reports that there have been 16,174 hospitalizations nationwide, and 1,379 deaths associated with the H1N1 infection.
At the present time, the states that are reporting the most widespread flu activity are Alabama, Alaska, Arizona, Arkansas, California, Colorado, Delaware, Florida, Georgia, Illinois, Indiana, Kansas, Kentucky, Louisiana, Maryland, Minnesota, Mississippi, New Mexico, North Carolina, Ohio, Oklahoma, Pennsylvania, Texas, Tennessee, Virginia, Washington and Wyoming.
Worldwide, more than 340,000 laboratory-confirmed cases of H1N1 and more than 4,100 deaths have been reported to the World Health Organization.
Given the unexpected and significant toll the Swine Flu has taken, efforts are well underway to make the H1N1 vaccine available to all. In spite of the significant controversy associated with this vaccine, it was estimated (by a CNN opinion poll in late August) that about two-thirds of Americans are planning to take the vaccine. The campaign to inoculate millions of Americans against the H1N1 Influenza began yesterday, October 5, with health-care workers in Indiana and Tennessee being the first recipients in queue for the vaccine. Nevertheless, in spite of the assurance of vaccine availability, it appears that widespread pandemonium remains around the nation due to the toll that H1N1 has already taken thus far.
My Comments – I believe that in spite of the significant and legitimate concern about the Swine Flu, common sense principles must apply and that they should not be overlooked with respect to prevention efforts. The evidence of previous pandemics suggests that there are those who appear to be able not to get sick in spite of widespread disease. What then, is the secret (if there is one), to avoid contracting a widespread virus or other infectious disease?
The above question is complex, and contrary to common opinion, I do not believe that simplistic answers can suffice. For example – It is well known that certain groups of people (such as pregnant women, chidren, young adults, and those with certain serious chronic conditions such as lung disease or diabetes) are often more susceptible to infectious diseases such as the Flu. This fact alone tells us that our ability to resist disease is highly individual; that it may depend on our unique biochemical individuality; and further, that it may be contingent upon numerous additional factors such as individual nutrient levels, rest/stress levels, and the state of our overall immunity. In addition, the level of exposure to disease is a critical factor as well. It is of course well known that those who spend the majority of time in public places or crowded areas are much more likely to succumb to the possibility of contracting an infection.
Notwithstanding the above, it behooves us (as it does in the case of all things we cannot control fully) that we do ALL we can to make every reasonable effort to prevent sickness. In spite of the alarm and concern surrounding the H1N1 virus, I find that too many people I meet appear to be unduly concerned about missing a week of school or work - and this, even after they have experienced the first symptoms of the Flu! Now, while I agree that missing work/school may be undesirable, perhaps this perceived loss needs to be viewed in terms of a much larger perspective. Through this post, I would like to remind as many readers as it reaches to seriously consider some of the statistics presented above. Upon reflection, would you not agree that the cost of work/school missed for a week, or even more time, is inconsequential relative to the cost and threat of the possible loss of life, or conceivably, even the permanent loss of health?
We all tend to think that the worst cannot or will not ever happen to us. But, the reality is that it can. With that reminder, please refer again to a previous post on some simple, but potent steps you can take to protect yourself (to the extent it is possible to do so) from the H1N1 virus – including staying home if necessary for a week or more in order to protect both yourself, and others. Certainly, the H1N1 virus is a formidable enemy, but even mere elementary observation suggests that oftentimes, we humans can be our own worst – and even more formidable – enemies relative to any virus or other external agent. Let this post be a reminder to us all to first be our own best friends!
Resources:
Earlier this month on September 7, I wrote an article on How to Use Drugs (Especially New Ones) Safely – And Why It Matters. This article appeared on GOOGLE NEWS Top Stories of the Day, Basil and Spice.com, and other online sites as Drug Interactions Cause Over 200,000 Deaths Each Year in U.S.A. In keeping with the theme of addressing critical issues pertaining to proper drug use, I am writing today about one of the most commonly used drugs familiar to all in the U.S. – A drug known as ACETAMINOPHEN (commonly addressed often as TYLENOL). As a research scientist who speaks regularly both to physicians and lay audiences on chronic disease prevention, I find that drug misuse or over use is perhaps one of the most lethal, yet unrecognized problems in Western nations. Indeed, it is a problem that has led both to an unnecessary and tragic loss of life, as well as loss of health for thousands. This is certainly the case for the drug we are about to discuss today.
In June of this year (2009), an FDA panel cited the alarming statistic that the commonly used painkiller Acetaminophen (popularly available over the counter in Tylenol, Excedrin, and dozens of other medications) was the leading cause of liver failure in the United States. The panel further cited that 60% of deaths involving Acetaminophen occurred when also taking one or more prescription medicines. In light of these numbers, I feel that it is critically important for ALL to understand how to use this widely and commonly used drug safely.
WHAT IS ACETAMINOPHEN ?
Acetaminophen is the generic name of a drug found in many over the counter (OTC) products such as Tylenol, as well as in prescription products such as Vicodin and Percocet. In the UK and several other countries, this drug is often referred to as Paracetamol. Acetaminophen’s main uses are to help relieve pain and reduce fever. It is frequently found in combination with other active ingredients, especially in medications used for allergies, colds or the flu.
INCORRECT ACETAMINOPHEN USE AND RISK OF LIVER INJURY:
Although Acetaminophen is generally considered safe if taken as directed, it is now well known that this drug can cause serious liver damage if more than the recommended amounts are taken. Symptoms of early stage liver damage may be loss of appetite, nausea, vomiting, or a perception of having the flu. Because these symptoms can often so easily be ignored as being not very serious, in most cases liver damage can go undetected. However, liver damage can quickly progress into liver failure or even death. Here are some simple cautions you can take to lower your risk of liver damage when using Acetaminophen:
- Follow dosage directions strictly as prescribed by your physician or as indicated on the drug label. Even a small amount of this drug – when used in excess of what has been directed – can cause liver damage or possible liver failure.
- Don’t take more than one medicine that contains Acetaminophen at one time. This is most likely to happen when you have symptoms such as those of a headache and a cold at the same time. Consuming two or more medications – each of which contains Acetaminophen - is extremely risky and must be avoided.
- Do not take Acetaminophen longer than is needed or for more days than is directed.
DEVELOP AWARENESS OF WHICH MEDICATIONS CONTAIN ACETAMINOPHEN:
All medicines have ingredients listed on their labels, but most individuals tend to ignore this information. Before taking any medication, read the medication label and the drug facts. If your medicine contains Acetaminophen as an active ingredient, be aware of how much you are taking, and refrain from combining it with other medications that also contain the same drug. Acetaminophen is often listed on over the counter drug bottles as APAP. It is NOT safe to use over the counter Acetaminophen if you are a regular alcohol drinker and/or have liver disease. If this is the case, consult your physician before you take this or any other pain medication.
SAFETY CONCERNS FOR CHILDREN:
All of the above precautions should be kept in mind when giving Acetaminophen to children. Due to the fact that it is very easy to overdose children accidentally, certain extra precautions must be taken as well:
- When dosing children, it is very important to use the measuring tool to dispense the medication that comes with it. Do NOT use a kitchen or other spoon to measure medication.
- Again, be especially cautious not to give a child more than one medication that contains Acetaminophen at one time. If the suggested dose does not provide needed relief, consult your doctor rather than risk overdosing.
EMERGENCY NUMBERS:
Research suggests that in spite of best efforts on the part of many, accidental overdosing can happen. If that is the case, waiting to get help can be fatal. If you suspect an overdose of Acetaminophen, immediately call 911 or Poison Control at 1-800-222-1222 to receive directions on the correct course of action to follow. As signs and symptoms of liver damage are often not noticeable for hours or even days after taking this drug, waiting may lead to severe liver damage, or death.
I hope this article will help you use Acetaminophen with much greater awareness than you may have had before. As with most medications, Acetaminophen is a useful drug when used correctly. However, a lack of simple awareness and knowledge vis-a-vis important precautions, that must be kept in mind to use this drug safely, has cost many lives. Please help build much needed awareness about this very commonly used drug by forwarding this post to any and all that might benefit from it.
FOR FURTHER READING:
ACETAMINOPHEN POISONING (Journal of the American Academy of Pediatrics)
McNeil Consumer Healthcare, the manufacturer of Tylenol products announced yesterday (September 24), that it detected bacteria in an inactive ingredient utilized in the production of several pediatric Tylenol products. In consultation with the Food and Drug Administration, the company has issued a voluntary recall of 21 chidren’s and infants’ Tylenol products that were manufactured between April 2008 and June 2008.
Although literature suggests that the risk of an infection is low upon the ingestion of a contaminated pharmaceutical product due to the fact that stomach enzymes are usually able to neutralize bacteria, concern remains for those patients who may have lung disease, cystic fibrosis, or perhaps a weak immune system.
For those who may have concerns or questions regarding this issue, McNeil Healthcare has provided a contact number. They can be reached at 1-800-962-5237 (M-F, 8 am to 8 pm Eastern Time). The full list of the recalled products and their lot numbers can be accessed at the following site (Lot numbers can be found at the bottom of the packages that contain liquid formulations, and on stickers that surround product bottles):
TYLENOL RECALLED PRODUCTS FULL LIST AND LOT NUMBERS
As an important aside, most individuals appear to be unaware of safety measures that have been published by the U.S. FDA for the use of Tylenol (generically known as ACITAMINOPHEN) - both for pediatric and for adult use. Due to the widespread reports of liver failure and/or liver damage associated with improper (or excess) Acitaminophen use, these guidelines are important to know. As this topic is fairly extensive, I shall be writing on this important subject shortly in an upcoming post. Until then, please pass on this post to those who have children and to others who may have need for this information.
Heart Disease, Cancer, Diabetes – Past Time to Address Primary Causes
What are the actual causes of death in the U.S. and in the Western nations? What is it that actually kills us? If you were to ask most anyone that question (including health professionals), chances are that the answer you would receive would be: Cardiovascular disease, Cancer, and Diabetes are our top three killers. But, are they really? Has that come to be the “expected” answer, or is it really the most accurate answer? In this post, I challenge you to delve a little deeper into understanding better the actual causes of death in the Western nations.
Cardiovascular disease, cancer, and diabetes may indeed be listed in any database as the top three killer diseases in the West. But, as one studies research carefully, it starts to become evident that these diseases are in fact NOT the Primary Causes of death; rather they represent what may be called the Secondary Causes of death in the vast majority of cases. What does this mean? In simple language, this means that if someone dies of a heart attack and we consequently conclude that the cause of death was heart disease – we are engaging in what may be called “circular reasoning.” The REAL question we must ask and answer is this: What was the Primay Cause or Causes of the heart disease in the individual who died? What caused heart disease to happen in the first place? And the same questions must be asked for cancer, diabetes, and other diseases. Why do this?
Here is the answer to the above question: There is mounting evidence to indicate that the vast majority of the actual causes of death (what I am here referring to as Primary Causes) are factors that are often well within our control. In 1993, a publication in The Journal of the American Medical Association (JAMA) concluded that of the more than 2 million deaths that occurred each year in the U.S. (around that time), more than half – or greater than one million -were occurring prematurely as a result of 10 specific behaviors that included the following:
- Tobacco use
- Poor diet
- Lack of physical activity
- Alcohol abuse
- Exposure to infectious agents
- Expsoure to toxins
- Unsafe sex
- Unsafe driving
- Illicit drug use
Of the one million deaths due to the above causes, more than half a million deaths were accounted for by the top three causes alone, i.e., tobacco use (smoking), being physically inactive, and eating poorly.
Since 1993, other scientific publications have appeared that have ratified the link between a poor diet, sedentary behavior and premature death. In 2000, another paper published in JAMA by the Centers for Disease Control indicated that tobacco use still remained the leading cause of death accounting for greater than 400,000 deaths that year. Another 350,000 deaths were attributed that same year to the combination of eating badly and being inactive. The question is: Does the link between the causes listed above and premature death still hold today?
Indeed it does. In 2008, researchers from Harvard published a paper in The British Medical Journal entitled, “Combined impact of lifestyle factors on mortality: prospective cohort study in U.S. women.” This study followed 80,000 women between the ages of 34 and 59 for more than 24 years. During that period, there were 9,000 deaths in this cohort – of which nearly 2,000 were attributed to heart disease, and 4,500 to cancer. But again, these could be called the Secondary Causes of death. What were the Primary Causes? In studying this sample, researchers found that 5 specific behavioral risk factors were the underyling actual causes of premature disease and death in these women. The 5 factors were these:
- Smoking
- Inadequate physical activity
- Poor diet quality
- Weight gain/obesity
- Alcohol intake outside of the recommended light to moderate range
Investigators concluded that the combination of the above 5 risk factors increased the overall risk of death more than four-fold in their sample; increased risk of cancer death by more than three-fold, and increased the risk of cardiovascular death more than eight times! These results can be restated as follows: The combination of not smoking, being physically active, eating sensibly and well, drinking within recommended guidelines, and maintaining a close to optimal weight is associated with a markedly lower mortality that is equivalent to a nearly 90% reduction in risk of death from heart disease, a 2/3rd or 66% reduction in the risk of cancer, and greater than 75% reduction in risk of death from any cause.
These numbers suggest that while it is true that we may not have absolute or 100% control over our destinies vis-a-vis our health, we are decidedly far from helpless. Indeed, it might not be an exagerration to say that what we are able to do with what we already know to influence the state of our health positively far exceeds any major medical breakthrough we may make tomorrow. This is not an argument against the benefit(s) of future medical research; rather, it is a call to action to energize ourselves to do all we can with what we already know.
At present, greater than two-thirds of Americans (165 million plus) are overweight, of which 30% are clinically obese. Similar trends are occurring all across other Western and Westernized nations. As an example, the World Health Organization recently stated that by 2010, 76% of men and 67% of women will be overweight in Australia. These numbers are equivalent to roughly three-quarters of the entire Australian population! There is no disputing the fact that overweight and obesity are closely related to heart disease, diabetes, and even certain cancers. Consequently, rates of these diseases are expected to be high wherever people are overweight or obese. Today, any way we look at it, the majority of those living in the West or in the Westernized world are sick. We are mired in an epidemic of overweight, obesity, and deadly chronic diseases.
So, what is our way out of this quagmire? Perhaps one way out is for us to start by clearly stating and distinguishing Primary from Secondary Causes of both illness and death. Is doing so really that essential? Yes, it is. Establishing and understanding the Primary Causes of disease is crucial to coming to terms with how much influence we truly have over disease and the state of our health. In the great majority of cases, heart disease, cancer, and diabetes don’t just “happen” to us. We are not completely helpless against these diseases. The reality is that we can exert tremendous influence over the state of our health as well as the quality and the duration of our lives. That statement is not mere opinion; it is a research-based fact.
Now, it is true that with our poor diets, our stress-filled hurried lifestyles, and our sedentary habits, many of us who live in the U.S. or other Western nation have been our own worst enemies for a long time. But, I am convinced that if we decide to, we can just as easily be our own best friends. Don’t you think its time?
Notes
Combined Impact of Lifestyle Factors on Mortality: Prospective Cohort Study in U.S. Women
It is interesting to note that nearly every time a celebrity or other well-known public figure dies of a cancer, there is – for a short time anyway – a great deal of news and attention given to the cancer that happened to be the immediate cause of death. Not very soon thereafter, the interest in learning or understanding more about the particular cancer in question generally fades away. In the wake of the recent tragic death of Hollywood icon, Patrick Swayze (on Monday, Sept 14), the news networks are currently ablaze with news about the cause of his death, i.e. Pancreatic Cancer. But, how long will the interest last – whether in the news or among the general public – in learning how to prevent this, or any another virulent cancer? Experience suggests: Not too long. The question is – Why?
As a research scientist who speaks frequently on Cancer (its current research, prevention, and treatment), I am intrigued to note that among all diseases that exist, Cancer is perhaps the most mis-understood of all diseases even in our current times. Audiences frequently tell me that they dread this disease more than any other because they perceive that it is the one disease they have the least control over. And because people erroneously perceive that they have little or no control over preventing the great majority of cancer(s), they tend to just “look the other way” – and especially so after the dust settles on the news of yet another favorite Hollywood star succumbing to this deadly disease.
But, it’s time to set the record – or at least some facts - straight. This post is not about Pancreatic Cancer, but about Cancer in general, and the facts that ALL should know. The facts are these: Research suggests unequivocally that only 5-10% of all cancer cases can be attributed to genetic defects, whereas the remaining 90-95% have their roots in an individual’s environment and lifestyle (1). Here is the official breakdown of known factors linked to cancer for all cancer-related deaths:
- Almost 25-30% are due to tobacco use
- As many as 30-35% are linked to diet
- About 15-20% are due to infections
- The remaining percentage is due to other factors such as exposure, stress, lack of physical activity, environmental pollutants, etc, i.e. “environmental factors.”
Research also suggests unequivocally that cancer prevention requires:
- Smoking cessation
- Increased ingestion of fruits and vegetables
- Moderate or no use of alcohol
- Caloric control
- Minimal meat consumption
- Whole grain consumption
- Avoidance of direct sun exposure
- Regular physical activity
- Prudent use of vaccinations as needed
- Regular check-ups
The bottom line? We can no longer say that we have no control whatsoever over preventing cancer. The vast majority of cancers are in fact preventable, but they do require major lifestyle changes for most individuals. Two critical factors that have been studied very extensively through research give support to the preventability of cancer:
1. The link between diet and cancer is revealed by large variations in the rates of specific cancers in various countries, and the changes observed in the incidence of cancer among those who migrate. For example: Asians have been shown to have a 25 times lower risk of prostate cancer and a ten times lower risk of breast cancer than do residents of Western countries, and the rates of these cancers increase substantially after Asians migrate to the West (2).
2. Extensive studies with identical twins have suggested that genes are not the source of most chronic illnesses. For example, the concordance between identical twins for breast cancer has been found to be only 20% (3). Data suggest that instead of our genes, our lifestyle and environment account for 90-95% of most chronic illnesses.
The details we must attend to – and the specific steps we can take - to modulate our risk factors in order to prevent cancer(s) are (needless to say) an extensive topic worthy of a full length book – one in fact that I am working on. However, the point of this post is simply to share a lesson that I have learnt through many years of study, and the lesson is simply this: Health and Disease are NOT random states. There are laws that govern each – and these laws are external, absolute and irrevocable. They operate regardless of our awareness or our ignorance of them, so that our state of health or disease is pivotally and critically contingent upon the extent to which we understand these laws. In simple language, this means that the sooner we learn about and align ourselves and our behaviors with the laws that govern a state of health, the sooner we are likely to arrive at that desired destination. The longer we stay in a state of ignorance or fear, the more likely it is that we (albeit unwittingly and unknowingly) succumb to disease – cancer or any other.
This year, more than 1 million Americans, and more than 10 million people worldwide are expected to be diagnosed with cancer. This disease continues to be a worldwide killer and accounts for about 23% of total deaths in the U.S., being the second most common cause of death after heart disease. However, unlike in the case of heart disease, there has not been an appreciable reduction in death rates for cancer in the U.S. in spite of an enormous amount of research dedicated to this disease. This fact alone should propel us all to learn all we can and do all we can to prevent cancer(s) from occurring in the first place.
What will you do today to that end? Here is a suggestion: Start by reading one of the two seminal resources provided at the end of this post. I assure you that when you do, you will not feel quite as helpless against cancer as perhaps you once did. And please, feel free to pass on this post and these resources to those in your circle of family and friends who may benefit as well - The world needs this information, and you can help.
NOTES
(1) Anand, et al. Cancer is a Preventable Disease that Requires Major Lifestyle Changes. Pharm Res. 2008; September 25 (9): 2097-2116.
(2) Food, Nutrition, Physical Activity and the Prevention of Cancer; Diet and Cancer Report
(3) A.S. Hamilton and T.M. Mack. Puberty and Genetic Susceptibility to Breast Cancer in a Case-Control Study in Twins. New England Journal of Medicine 348: 2313-22 (2003)
RESOURCES
Anand et al. Cancer is a Preventable Disease that Requires Major Lifestyle Changes. Cytokine Research Laboratory, Dept. of Experimental Therapeutics, The University of Texas M.D. Anderson Cancer Center.
THOMAS QUASTOFF: PHARMACO-EPIDEMIOLOGY'S FIRST FACE
In 1957, an anti-convulsive medication came on the market. In the late 1950s, thousands of German and other European women used this apparently safe anti-nausea/anti-convulsive and sleep medication during pregnancy. By 1960, this drug was marketed in 46 countries, with sales nearly matching those of Aspirin. In 1961, this drug was withdrawn from the market after being found to be a cause of “Phocomelia” – a birth defect so severe that it caused children to be born without properly developed arms or legs. The drug was Thalidomide. It is estimated that the number of individuals that were directly affected by Thalidomide was between 10,000 and 20,000. It was a tragedy of enormous proportions, and our first full understanding of the fact that drugs can be toxic. The field of Pharmaco-Epidemiology was born in tragedy.
Today, it is estimated that adverse drug side effects and drug interactions account for over 200,000 deaths each year in the U.S. alone – which equals approximately 4000 weekly fatalities. This estimate is according to the Alliance for Aging Research’s Report to Congress that was made in 2001. This number supports a previous estimate made by The Journal of the American Medical Association (JAMA) in 1995 that reported deaths from adverse drug events to be at 180,000 per year at that time. The JAMA esimate was considered conservative even then in light of the rapid introduction of new drugs on the market.
More recently, the tragedies surrounding the use of Rofecoxib (Brand name – Vioxx) and several other drugs have raised concerns about the safe use of newly emerging drugs. For example, when Vioxx was withdrawn from the market in September 2004, 80 million people worldwide were using this drug for conditions such as arthritis and acute pain. This was one of the most widely used drugs ever to be withdrawn from the market, with revenues of U.S. $2.5 billion in the year before its withdrawal. The fact that this drug had very serious and potentially fatal side effects was learnt after it had been on the market for a period of time and was fully in use.
The tragedies surrounding Thalidomide, Vioxx, and numerous other drugs (not mentioned here) give us pause to re-consider how to use drugs safely, especially if they are new to the market. There are times when it may be promising to consider the use of a new drug for a specific condition or conditions, but is there a way we can be aware of certain cautions we must keep in mind while doing so? While this topic is by itself a very large field of study, there are certain principles and hard lessons that have been learnt over time through the study of Epidemiology that everyone should know about, and I will share these with you in this post. These principles help us to use new drugs with greater awareness and objectivity, and also increase our understanding of how we may be able to circumvent a crisis in the event of an adverse drugs event and/or a drug interaction.
When using a new drug (or multiple drugs), a patient or physician must at first draw an informal inference in the event of an unexpected drug side-effect or an unanticipated drug interaction problem. Here are the critical criteria on the factors involved in doing so – I will explain what they mean at the end of the table below:
|
Informal inference When it’s easy Very short time interval Prior hypothesis Known mechanism No alternative explanation Simple exposure
|
Informal inference When it’s hard Symptoms are delayed Unanticipated No known mechanism Expected in absence of drug Multiple treatment modalities YOU CANNOT AFFORD TO NOT BE ALERT |
While the contents of the above table may seem esoteric at first, this is information that ALL individuals must take a little time to understand and learn:
1) The column on the left defines the criteria using which we can determine that there may be a problem with a new drug you have taken. If immediately or soon after taking a new drug, you feel unusual symptoms that make you feel perceptibly uncomfortable or anxious; if there is a prior hypothesis or known mechanism indicating that such a symptom or symptoms may occur (usually such factors are mentioned on the inserts that come with the drug), and if the new drug is the ONLY new item you have added to your intake - It is time to draw the informal inference that there may be a problem with this drug’s use for you. At such a time, rather than taking another dose of the same drug on the prescribed schedule, you should discontinue use of this drug and contact your doctor immediately to make him/her aware of your concerns.
2) Sometimes, however, it is not so easy to determine if a new drug you have taken is causing a problem, or if there are other factors that may be involved. The column on the right defines the factors that make the drawing of an informal inference hard with respect to the true effects of a new drug. For example, the effects of a new drug may be delayed; they may be unanticipated, and there may be no prior known mechanism or hypothesis vis-a-vis the symptoms you are experiencing (i.e., they may be readily expected even in the absence of the drug). Further, you may be taking multiple drugs and it may be impossible to know which one of the drugs is causing a problem (or if drug-interactions are involved). A good example of when informal inference was hard was what happend with Thalidomide – Its effects were delayed, unanticipated, and no one knew of any prior hypothesis or mechanism that indicated that its use might result in the culmination of a tragedy.
So, what can you do to protect yourself from an unanticipated crisis that might happen with the use of a new drug or while using multiple drugs? First, use the criteria above as a guide to develop greater awareness surrounding drug use. Be alert at all times for any and all unsusual symptoms, especially when using multiple drugs. Here are additional guidlelines you should keep in mind:
- Have a trusted primary care physician (PCP) whom you can contact without hesitation in case of an emergency.
- Have serious respect for drugs; Do not take any drug casually or without due awareness.
- Ask and research information regarding drug interactions.
- It may not always be possible, but when it is, choose drugs that have been on the market for at least 5 years, or drugs that have a long history of safe use.
- Read all directions, precautions and potential adverse reactions – This information is made available when drugs are purchased, but few individuals take the time to read it seriously.
- Follow-up on ALL physician recommended lab work! – Too many patients refuse to follow-up on recommended blood work or lab tests that have been recommended. This can be potentially fatal.
- If you suspect any unusual reaction, don’t wait – follow-up with your PCP immediately.
- Don’t take Over the Counter (OTC) medications or herbal therapies lightly.
- Know when OTC drugs are contra-indicated.
- Consult and inform your physician and pharmacist when taking OTC’s.
- Finally, do not self-medicate to address an unexpected problem, and do not self-diagnose. Obtain confirmation from your doctor with regard to the correct action to take in the event of an unexpected crisis.
Arriving from thin data to causal knowledge with respect to the true effects of a drug, or of drug-related interactions, can sometimes take years and expert epidemiologists often study extensively to understand this difficult field of study. The point of this post, however, is simply to draw your attention to the fact that simple awareness and even a cursory level of knowledge with respect to the important factors you should bear in mind – can sometimes be sufficient to avert a crisis. It is also important to know and take advantage of useful resources that can keep you well-informed and on the alert with respect to potential drug-interactions and/or news pertaining to safety issues involved with new drugs. I have listed a couple of the most useful resources on this subject at the end of this post.
Finally, as this subject is both critically important and very vast, no single blog post can do full justice to it. For this reason, I will post a video series on this topic in the upcoming days or weeks. Stay tuned for that. Until then, please feel free to pass on this post and the resources provided to all who may benefit.
RESOURCES:
Drug Interaction Table (Indiana University Division of Clinical Pharmacology)
INTERNATIONAL UPDATE
The latest update on the international situation on the H1N1 virus was recently reported by the World Health Organization on August 23, 2009. As of that date, the total number of laboratory confirmed cases of the 2009 H1N1 virus were 209, 438 with at least 2, 185 deaths. The laboratory confirmed cases represent an underestimation of the actual number of cases of H1N1 worldwide as most countries now focus surveillance and laboratory testing in persons with severe illness only.
Overall, at present, decreases in disease due to the H1N1 virus are being reported from South America, parts of Australia, and the U.K. On the other hand, increase in disease due to the H1N1 virus is being reported from more countries in Africa, Southern Africa, and other tropical countries.
UNITED STATES UPDATE
The latest report on the domestic situation with the H1n1 virus is from the week of August 16-22, 2009. The Centers for Disease Control (CDC) estimate that the H1N1 activity is either stable, or increasing in some areas of the U.S. H1N1 activity appears to be increasing in the SouthEast (especially the state of Georgia) based on data reported by health care providers in that area.
Most state officials across other parts of the country are currently reporting regional or sporadic influenza activity. However, Alaska and Georgia are the two states that are reporting widespread influenza activity at this time.
Both in the U.S. and internationally, the H1N1 virus continues to be the most dominant virus in circulation. With rare exceptions, the H1N1 virus continues to be susceptible to the antiviral drugs Oseltamivir and Zanamivir. Read more on the resistance of the H1N1 virus to certain antiviral drugs; how antiviral drugs help provide protection against and treatment for Swine Flu, dosage recommendations, and guidelines for use of antiviral medications at the following link: Antiviral Drugs and The Swine Flu – Getting Equipped.
The World Health Organization (WHO) has reported a status update with respect to international statistics on the Novel H1N1 virus. As of August 13, 2009, WHO regions have reported182,166 laboratory-confirmed cases of the Novel H1N1 influenza virus (new H1N1) with 1,799 deaths. The laboratory-confirmed cases are believed to be an underestimation of total H1N1 cases in the world as many countries have shifted to strategies of clinical confirmation and prioritization of laboratory testing only for persons with severe illness and/or high risk conditions.
At present, the Novel H1N1 virus continues to be the dominant Influenza virus in circulation in the world – 71% of all Influenza viruses currently detected globally are the new H1N1. The Novel H1N1 virus also currently accounts for 66% of Influenza viruses in the Northern Hemisphere and 89% of Influenza viruses in the Southern Hemisphere.
According to WHO, in the face of the rapid spread of a pandemic virus worldwide, regulatory authorities often have to allow for great flexibility in developing procedures for fast-tracking the approval and licensing of pandemic vaccines. However, numerous media reports seem to have expressed concern about the safety of vaccines for the H1N1 pandemic influenza due to the fast-tracking procedures in place to bring the vaccine to the market. The main concern is that the fast-tracking approval of a drug or vaccine generally leads to a situation in which the true adverse effects of the administered agent are fully observed only after the agent has appeared on the market (i.e. at the time of post-marketing surveillance). Other concerns include the vaccine manufacturing procedure itself. Numerous individuals appear to be concerned with the use of eggs in the H1N1 vaccine manufacturing process.
Due to the above concers, WHO headquarters issued a briefing recently stating that the regulatory procedures in place for the licensing of pandemic vaccines, including procedures for expediting regulatory approval, are rigorous and do not compromise safety or quality controls.
For those concerned about the safety of the H1N1 vaccine and/or its manufacturing process, here are some useful resources for further study:
WHO latest briefing on the safety of pandemic vaccines
Pandemic influenza vaccine manufacturing process and timeline
The World Wide Web is an enormous smorgasbord of information, and while it is an incomparable asset to have at hand; for many it can often be more than a bit daunting to discern which sites are trustworthy. With respect to information on health and research, this concern becomes even more valid. As I have received numerous inquiries over time with respect to which websites one should have on hand for reference with respect to critical health-related issues, I decided to write this post as a brief guide to some of the key sites that may be of benefit to most. Please note that there are hundreds of good sites on the web; here, I am listing only 5 sites – largely on the criteria of their usefulness in terms of providing regularly updated information on issues of public health concern, and the immediacy of their usefulness as valuable health resources:
1. CDC’s MMWR (Morbidity and Mortality Weekly Report): Most people are aware of the Centers for Disease Control (CDC) Website, but few seem to know of CDC’s weekly online publication known as the MMWR. MMWR is often referred ![mmwr-logo-b[1]](http://thepreventionrevolution.files.wordpress.com/2009/08/mmwr-logo-b112.gif?w=293&h=62 "mmwr-logo-b[1]"){kind=logo}
to as “The voice of CDC,” and is CDC’s main method of publishing timely and useful public health information and recommendations that have been received by CDC from the state health departments. Each issue covers reports that have been received in the week through Friday, that are then published on the following Friday. This is an invaluable site to have on hand, especially with respect to issues concerning emerging infectious- or other critical- diseases of public health concern. You can subscribe to the MMWR for free using the link above.
2. Indiana University Division of Clinical Pharmacology (The Cytochrome P450 Table): While this site may seem ![iu_logo[1]](http://thepreventionrevolution.files.wordpress.com/2009/08/iu_logo12.jpg?w=176&h=44 "iu_logo[1]"){kind=logo}
esoteric to most individuals not directly involved in the field of Medicine, it is in fact a valuable site for all. Why? In a nutshell – The Cytochrome P450 is a family of 60 plus enzymes that the body uses to break down toxins and drug metabolites. Occasionally, individuals may be on several drugs that may use the same family of enzymes (i.e. The Cytochrome P450 family) for detoxification of the metabolites of the ingested drugs. In non-technical terms, this can lead to drugs competing for the same enzyme system for clearance of their metabolites, and this is a situation that can be life-threatening. This is a complex topic, and my objective here is primarily to make you aware that this is an important issue to be aware of, especially if you are taking multiple drugs for several different conditions at the same time. You can download The Cytochrome P450 Drug Interaction Table and take it to your physician in the event you have concerns about drug interactions. Please be sure to read the Disclaimer stated by Indiana University at the bottom of link 2 above.
3. FDA/Drugs: Another useful site to have on hand with respect to information on drug recalls and alerts, drug ![img_fdagov_logo_type[1]](http://thepreventionrevolution.files.wordpress.com/2009/08/img_fdagov_logo_type11.gif?w=300&h=28 "img_fdagov_logo_type[1]"){kind=logo}
approvals and clearances, and for critical emerging information on drug-related topics is the FDA/Drugs site. You can report a serious medical problem related to a drug at this site, and can also have access to regularly updated, often life-saving information on drug safety.
AND NOW…ONTO A COUPLE OF SITES ON FOOD AND HEALTH:
4. Harvard’s The Nutrition Source: Enjoy Harvard School of Public Health’s The Nutrition Source – a website maintained by the Department of Nutrition at Harvard. This site provides valuable tips on healthy eating based on a ![harvard[1]](http://thepreventionrevolution.files.wordpress.com/2009/08/harvard11.gif?w=300&h=29 "harvard[1]"){kind=small}
body of solid, scientific research.
5. Eat Well Guide: Sustainable Table’s Eat Well Guide helps you find local, sustainable or organic food anytime, ![logo-tag[1]](http://thepreventionrevolution.files.wordpress.com/2009/08/logo-tag1.png?w=300&h=92 "logo-tag[1]"){kind=logo}
anywhere in the U.S. and Canada. A great resource to have on hand to find farm fresh food, local farmer’s markets, and restaurants simply by entering your zip code in the search feature on the Eat Well Guide. If you are planning a trip, Eat Well Everywhere can help you with a printable map of the best local food markets on your travel itinerary.
Quality health sites can provide information that may be of lasting value, and occasionally, knowledge that may even be life-saving. I am open to feedback on whether you as a reader find a post of this nature (one that refers you to valuable, non-commerical resources) beneficial, and whether you would like to see additional similar posts occasionally.
Earlier this year, researchers Robert W.-L. Ma and K. Chapman conducted an evidence-based review of dietary recommendations in the prevention of Prostate Cancer as well as in the management of patients with Prostate Cancer. The review was published in the Journal of Human Nutrition and Dietetics. Although numerous studies have been published that have evaluated the role of diet in both the prevention and management of Prostate Cancer; it is important to remember that review studies are particularly salient in that they enable us an overview of the “totality” of the evidence thus far with respect to an association under study.
It is often easy to forget the results of review studies, as new and more compelling studies often tend to make the news headlines. For this reason, the results presented by critical review studies are often forgotten, but are worth reiterating. Ma and Chapman’s paper entitled A systematic review of the effect of diet in prostate cancer prevention and treatment reviewed the data for dietary-based therapy in the prevention of Prostate Cancer with an aim to provide clarity surrounding the role of diet in preventing and treating Prostate Cancer. Salient conclusions derived from this review indicated that a diet that may be effective in preventing Prostate Cancer is one that is:
1. Low in fat
2. High in vegetables and fruits
3. Low in an overall energy intake
4. Low in meat consumption, and
5. Low in dairy products and calcium intake.
More specifically, according to the review – the consumption of tomatoes, cauliflower, broccoli, green tea, and vitamins including Vitamin E and selenium seemed to propose a decreased risk of Prostate Cancer; whereas the consumption of highly processed or charcoaled meats, dairy products, and fats seemed to be correlated with Prostate Cancer.
Although no single study – or even one that is a systematic review of other studies – can generally give us all the information we may want to have in order to make an unequivocal connection between the variables of interest; the point of this post is this: In Epidemiology, as in many other fields, researchers look for “consistency of evidence.” This means that as we gather together a body of scientifically sound studies, we look for valuable corroborative information that often supports previously obtained results. In the case of the association between diet and Prostate Cancer, it now appears quite clear that undertaking dietary modifications in line with the guidelines suggested above generally has a beneficial effect for most individuals – both with respect to the prevention of this cancer, as well as in its management in the event of an occurrence.
![katzguidetoprostate[1]](http://thepreventionrevolution.files.wordpress.com/2009/08/katzguidetoprostate11.jpg?w=183&h=280 "katzguidetoprostate[1]")
Finally, although the above guidelines are useful, they are cursory in nature, and there is certainly a lot more to learn about how to prevent Prostate Cancer pro-actively, or manage it effectively in the event it has already occurred. An excellent book that may benefit many to that end is Dr. Katz Guide to Prostate Health – From Conventional to Holistic Therapies (Author: Aaron Katz, MD/Freedom Press).
In the final analysis, being truly well-informed, well-read, and therefore, well-equipped is perhaps the best aresenal to beat most any chronic disease. Take the time to become so equipped.
Notes:
Ma et al. A systematic review of the effect of diet in prostate cancer prevention and treatment. Journal of Human Nutrition and Dietetics, 2009; 22 (3): 187 DOI: 10.1111/j.1365-277X.2009.00946.x
How Whole Grains Protect Against Heart Disease, Diabetes, Cancer(s), and Menopausal Problems
A book could easily be written on the topic of how the consumption of whole grains protects us from a myriad of chronic diseases. However, in this post, I will touch upon how whole grains affect the course of the top three diseases of the greatest concern in America and the West; and also on how whole grains can greatly alleviate the difficult symptoms often associated with menopause for many women. Most people have a notion that they should consume some whole grain foods, but fail to realize the pivotal role of regular whole grain consumption is creating long-term health. As this topic is very extensive, I will deliberately stick to just the key points here – points worth remembering on your way to preventing deadly chronic diseases pro-actively:
1. WHOLE GRAINS EQUAL LESS HEART DISEASE: Several studies have helped us to understand and confirm the connection between whole grain consumption and reduced rates of heart disease. Studies published in the Journal of the American Medical Association (JAMA) and the American Journal of Clinical Nutrition (AJCN) in 1999 reported that women in the Nurses’ Health Study who ate the most whole grain foods ( an average of 2.5 servings a day), were 30% less likely to develop heart disease than women eating the fewest (about 1 serving a week). It is estimated that eating a bowl of breakfast cereal that contains about 5 grams of fiber cuts the chance of heart disease by about one-third. These results are ratified by other high quality epidemiologic studies as well.
2. REGULAR WHOLE GRAIN CONSUMPTION SIGNIFICANTLY REDUCES THE RISK OF DEVELOPING TYPE 2 DIABETES: Epidemiologic research unequivocally suggests that whole grain consumption is fundamental to keeping the body’s blood sugar levels in the ideal range. Harvard’s Nurses’ Health Study as well as the Health Professionals Follow-Up Study confirmed that those who ate the most cereal fiber from grains (about 7.5 grams per day – which translates to approximately a bowl of oatmeal and 2 slices of whole grain bread) were 30% less likely to develop Type 2 diabetes as compared to those who ate the least grain fiber (less than 2.5 grams per day). Conversely, the consumption of a combination of low cereal fiber and a high sugar load (from white bread, colas, white rice, etc.) more than doubled the risk of developing Type 2 diabetes.
3. WHOLE GRAINS HELP WARD OFF MANY CANCERS: Meta-analyses (several “pooled” analyses) of many epidemiologic studies suggest clearly that whole-grain consumption reduces the risk of developing several cancers including stomach, colon, mouth, gall-bladder, and ovarian cancer(s). The pathways through which whole grains protect against all these conditions are not fully understood, but research suggests that the many components of whole grains such as B-vitamins, phytoestrogens, fiber, etc. may all be involved in offering protection against several cancers.
4. WHOLE GRAINS CAN HELP ALLEVIATE DIFFICULT MENOPAUSAL SYMPTOMS: For most women, one of the central problems associated with menopause is the fluctuation in estrogen levels that occurs during this stage of life, and the simultaneous bone-loss that often occurs. Research suggests that fortification of the diet during this time with high quality calcium and magnesium rich foods can help blunt bone-loss, relieve symptoms such as head-aches, and also regulate blood pressure levels. The bran layer of many whole grains contains essential minerals such as calcium, magnesium, copper, selenium, and manganese – all of which play crucial roles in maintaining metabolic and hormonal health. Women going through menopause should therefore pay especially close attention to the regular consumption of whole grains.
PUTTING IT INTO PRACTICE
The points made above ought to motivate us all to make a more concerted effort to include a variety of whole grains in our meals. But, old habits often die hard, and most Americans are hard-wired to eating refined foods. Here are 5 simple suggestions that will help you make a jump-start on improving your whole grain consumption:
1. THINK BREAKFAST: Always start the day with a whole-grain based breakfast. You can have a bowl of cold whole-grain cereal or a hot cereal made with a mixture of whole grains. Numerous varieties are now available in whole-foods stores. Look for oats that have been steel-cut (rather than instant or quick oats) and/or other cereal mixes that contain whole wheat, barley, oats, or whole rye meal.
2. SNACK ON WHOLE GRAIN-BASED FOODS: A small lunch or snack can easily consist of a whole-wheat pita pocket with roasted red pepper (or other) hummus, avocado slices, and fresh lettuce/watercress/other greens. Also, look for 100% whole grain crackers and try them with a little organic goat cheese or freshly made hummus – Delicious and Nutritious!
3. TRY HIGH QUALITY, WHOLE GRAIN PASTA: Do you think that whole grain pasta tastes too heavy? Here are a couple of ideas – Try whole-wheat thin spaghetti or angel-hair pasta rather than “regular” spaghetti, and occasionally, try some of the imported Italian brands. The thinner versions of the pasta lighten the taste of the whole wheat, and for now, there appears to be a broader selection of these foods in the imported brands.
4. LOOK FOR 100% WHOLE GRAIN BREADS: With more customers asking for whole foods, American grocery stores are adding newer varieties of whole grain breads regularly. However, it can take a while to decipher the labels on breads. Whenever possible, buy breads that contain 100% stone-ground whole wheat or other grain flours (as the first ingredient), and look for varieties that are NOT loaded with enriched flour.
5. STRETCH AND EXPLORE UNFAMILIAR GRAINS!: There is a whole world of fabulous whole grains out there - Sadly, most individuals in the West are not familiar with them. Growing up in India, I was exceptionally fortunate to learn how to use what (at that time) seemed like a nearly infinite variety of grains that were used in unimaginably delicious ways. Consequently, one of my passions is to share that wealth of knowledge with my Western friends and audiences. As both a passionate chef as well as a research-scientist, I see this knowledge as being of a kind that simply must be shared.
I’ll conclude this post with a question that I have been asked more often than I can remember: “I want to eat whole grains, but, what exists past whole wheat flour?” To begin with, a treasure of grains such as whole barley, millet, rye, an unending variety of lentil flours, and combinations of lentil and whole grain flours used for making uncommonly delicious flat breads. All of these foods provide an unparalleled bounty of taste and health. I am aware that manyof these foods may be alien to most in the West, but this is a treasure worth learning about and tapping into. In both my upcoming book, as well as in future posts, I will write frequently on the subject of whole foods. So, stay tuned for fabulous, one-of-a-kind mouth-watering whole foods recipes from around the globe, as well as other ideas on how to use whole grains and whole foods for creating a lifetime of vibrant health.
Until then, Bon Appétit!
There seems to have been a raging controversy for quite some time now surrounding the question of whether pesticide residues in food(s) contribute to health problems – especially certain types of cancers. Research, especially from the National Cancer Institute (NCI), quite clearly shows a connection between the occupational use of pesticides and certain cancers. For example, an association between pesticide use and prostate cancer risk has been observed among farming populations (1). Pesticide use has also been linked to a higher risk of pre-cancerous multiple myeloma among those who use pesticides occupationally, particularly farmers (2). However, the issue that appears to be one that is contentious is whether pesticide residues in food are a matter of concern for all of us.
Based on several scientific studies listed on their site, The Environmental Working Group (EWG) asserts that different pesticides in the foods we eat have been linked to a variety of toxic effects, including nervous system disorders, hormonal and carcinogenic effects, and skin, eye, and lung irritation. The EWG claims that the acceptable pesticide residue levels for fruits and vegetables established by the The Environmental Protection Agency (EPA) are too high, and that not enough studies have been done to measure the effects of low-level and multiple pesticide exposure – a reason that warrants due caution with respect to pesticide intake through foods.
On their website, the EWG presents The Shopper’s Guide to Pesticides that ranks pesticide contamination for 47 popular fruits and vegetables based on an analysis of 87,000 tests for pesticides on these foods, conducted from 2000 to 2007 by the U.S. Department of Agriculture and the Food and Drug Administration. They state that nearly all the studies used to create the list test produce after it has been rinsed or peeled. You can view more details on the methodology used to create this guide at the EWG website.
As an epidemiologist, I am inclined in this case to agree with the conclusions arrived at by the EWG. Pesticides – though often considered a necessary evil – are by definition agents that have an inherent toxicity. For this reason, it makes sense to minimize our exposure to these agents. And, precisely because we do not have long-term studies or data to help us decisively know to what extent ingestion of pesticides may be harmful, it seems only prudent for us to err on the side of caution. To that end, the EWG has created a useful guide.
![09shoppersguide-purpleimage[1]](http://thepreventionrevolution.files.wordpress.com/2009/08/09shoppersguide-purpleimage12.jpg?w=295&h=376 "09shoppersguide-purpleimage[1]")
On the left is a list of “The Dirty Dozen” or the fruits and vegetables found to be most contaminated with pesticides. It makes good sense to try to buy the organic versions of these foods, whenever possible. The guide also lists “The Clean 15″ – a list of fruits and vegetables that have been found to be the least contaminated when grown conventionally. EWG simulation studies show that by avoiding the top twelve most contaminated fruits and vegetables and eating the least contaminated ones instead, consumers can lower their pesticide exposure by nearly 80%.
As a closing note, I fail to see why the matter of minimizing our pesticide intake through choosing certain foods is one that is surrounded by as much controversy as it is. In matters pertaining to our health and well-being, when we do not have “all the information” we would like to have, it is prudent to do what we can (based on what we do know) to minimize our risk to exposures that may have the potential for harm – perhaps even significant harm. And, I might add that in the final analysis, minimizing risks is what health research is all about.
Is it ever an error to err on the side of safety on issues that may have a direct bearing on our very life and health? I think not. And you? – What say you?
Notes:
(1) http://www.cancer.gov/newscenter/pressreleases/AgricultureHealthStudy
(2) http://www.cancer.gov/newscenter/pressreleases/AHSmyeloma
Resources:
A study published yesterday (Aug 10, 2009) in The Archives of Internal Medicine concluded that breast-feeding is inversely associated with the incidence of breast cancer among high-risk women, i.e., among women who have a family history of breast cancer.
Results of this study are noteworthy for several reasons. This was a prospective cohort study with a large sample size. In this study, researchers followed 60,075 women for more than nine years. These women were participants in the cohort of the Nurses’ Health Study II from 1997 to 2005. Due to the fact that data from large, prospective cohort studies had thus far been lacking to study the relationship between lactation and incidence of premenopausal breast cancer; this study adds significantly to our body of knowledge on this subject.
Researchers in this study found that breast-feeding did not affect premenopausal breast cancer risk for women who didn’t have breast cancer in their family. However, for women with at least one close relative with breast cancer — a sister, mother, or daughter – breast-feeding cut the risk of premenopausal cancer by 59 percent compared to those who didn’t breast-feed. The main results of the study suggest that:
1) Nursing can cut the risk of breast cancer in more than half for high-risk women, and
2) The effect of breast-feeding may be the equivalent of taking the drug Tamoxifen for 5 years in those who are at high-risk for breast cancer.
Given that at present, the only conventional options for pro-actively preventing breast cancer for women who are at high risk are Tamoxifen use or Prophylactic Mastectomy – the results of this study represent good news.
My comments: This study supports previous observational data on the inverse association between lactation and premenopausal breast cancer; its results are thus confirmatory in nature. Still, it is important to bear in mind that it is generally not feasible, or even possible, for any one study to rule out all confounding variables that contribute to either the genesis or the prevention of disease. For example: Nutritional status, body weight, and lifestyle factors are relevant variables in either the genesis or the prevention of breast and other cancers. It is difficult to know to what extent these other factors may also have played a role in the lower rates of cancer among the high-risk, breast-feeding women.
The bottom-line: Based on the evidence thus far, breast-feeding is highly advisable, especially for women who have a family history of breast cancer. In light of the larger body of research, close attention to maintaining body weight at a normal level, as well as achieving an optimal nutritional status is equally advisable.
Resources:
With schools re-opening this week across most of the U.S., there is a great deal of concern and anxiety about the spreading of the Swine Flu virus. The reason for the concern is legitimate as the H1N1 virus is considered to be extremely contagious; thus due precaution (but not panic) is warranted. One of the reasons that Swine Flu/other similar types of Influenza that jump from animals to humans are considered especially dangerous is because humans have not had a chance to build any natural immunity against the pathogens that transmit these infections.
The Novel H1N1 vaccine will be available shortly; however, in the meantime, a few cautions bear reiterating as students and teachers get ready to return to school this week. Here are the top 5 things you can do to protect yourself pro-actively from catching the virus:
1. Consciously take several breaks during the day to wash your hand frequently with soap. Encourage children to do the same.
2. Do not touch your nose, eyes, or mouth unless you have thoroughly washed your hands. Avoid hand-to-face contact to the extent possible.
3. If anyone around you is coughing, sneezing, or has other flu symptoms, deliberately avoid close contact with them.
4. Carry your own water bottle(s) rather than drink from a community water fountain. Do not share your water bottle with others.
5. If there is a Swine Flu breakout in your community, avoid being in public places or large gatherings. If possible, stay home from work or school temporarily, and avoid traveling by public transportation.
The simple precautions above can help you to improve your chances of warding off the virus significantly. In addition to the resources from the Centers for Disease Control provided previously, you may also want to refer to the following special resources from The Harvard Medical School:
1. A report, entitled: Swine (H1N1) Flu: How to understand your risk and protect your health. This report has been prepared by the editors of the Harvard Health Publications in consultation with Raphael Dolin, M.D., Professor of Medicine, Harvard Medical School.
2. Special health report, entitled: Viruses and Infectious Diseases: Protecting yourself from the invisible enemy. This report has been prepared by the editors of Harvard Health Publications in collaboration with Michael N. Starnbach, Ph.D., Professor of Microbiology, Harvard Medical School.
Stay safe, stay well-informed, and protect yourself.
A new study by researchers at Kaiser Permanente’s Division of Research and the University of Kuopio in Finland recently concluded that elevated levels of cholesterol in mid-life influence the risk of developing Alzheimer’s Disease or vascular dementia later in life. This study tracked nearly 10,000 people for four decades, starting when the participants were between 40 and 45 years of age. After controlling for weight, hypertension, and diabetes, the study found the following:
1) Participants who had high cholesterol, or a value of 240 mg/dl or more, had a 66 percent greater risk of developing Alzheimer’s Disease later in life, and
2) People with borderline-high cholesterol, between 200 and 239 mg/dl, had a 25 percent spike in risk.
This study merits our attention for two reasons: First, although previous studies have linked heart and brain health, this is one of the first studies to examine the association between borderline high cholesterol levels and dementia. Second, the study’s sample size and design weigh in its favor. Long-term cohort studies (also known as Prospective Studies) that: i) have a substantial sample size; ii) measure study endpoints both through and at the completion of a considerable length of time (in this case, four decades); iii) control for important confounding variables; and, iv) do so across a diverse study population – give us some of the most valuable information in research.
As millions of individuals in Western nations have borderline or high cholesterol levels during mid-life, I am certain that many may be alarmed by the results of this study. The good news, however, is that for most individuals, a combination of sound dietary habits, moderate exercise, and a conscious effort to reduce stress levels can help achieve healthy – or even optimal – cholesterol profiles. Further, a large body of corroborative epidemiologic research suggests that a diet rich in quality whole grains, abundant fresh fruit and vegetables, mono-unsaturated fats such as olive oil, largely vegetarian proteins such as legumes, and a limited amount of red meat can contribute substantially to achieving a healthy lipid profile.
By now, we know what a quality whole-foods diet (that is based largely on plant foods) and moderate daily exercise can do for us. This study is one more reason to – Just do it!
Very recently, The American Journal of Clinical Nutrition (AJCN) published a study conducted by the Department of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, UK. The study was supported by the UK Food Standards Agency, and was entitled, Nutritional quality of organic foods: a systematic review.
The above study was founded on the premise that in spite of the growing consumer demand for organic foods, accurate information regarding the nutritional quality of organic foods is lacking. The study sought to quantitatively assess the differences in reported nutrient content between organically and conventionally produced foodstuffs. To accomplish this task, study researchers identified 162 studies (137 crops and 25 livestock products) and deemed 55 of these studies to be of satisfactory quality for actual analysis. Here are the main results of the study:
1. Conventionally produced crops had a significantly higher content of nitrogen, and organically produced crops had a significantly higher content of phosphorus and higher titratable acidity, and no evidence of a difference was detected for the remaining 8 of 11 crop nutrient categories analyzed.
2. Analysis of the more limited database on livestock products found no evidence of a difference in nutrient content between organically and conventionally produced livestock products.
In light of the above results, the conclusion of the study reads as follows: On the basis of a systematic review of studies of satisfactory quality, there is no evidence of a difference in nutrient quality between organically and conventionally produced foodstuffs. The small differences in nutrient content detected are biologically plausible and mostly relate to differences in production methods.
The point of this post? As an epidemiologist and a researcher myself, I am greatly intrigued by the results of this study, and feel that it is necessary to comment on it constructively. Researchers in this study sought to compare the nutrient content between conventionally and organically grown foods, and essentially concluded that there was no evidence of meaningful nutrient differences between the two; Further, if small differences did exist, they would be because of differences in production methods.
The point I would like to make here is this: Production methods are precisely the point of departure, and the key difference between conventionally and organically grown foods, and they do matter. While I applaud the researchers for doing a nutrient quality comparison between conventionally and organically grown foods, it is important to point out that there are several other endpoints that are relevant to health – which were not part of this study. And, they do indeed relate to production methods. Here are just a few of the many questions that still remain unanswered:
1. Did conventional foods and livestock products have higher amounts of antibiotic, hormone, or pesticide residues?
2. Did foods produced by conventional methods involve the use of Genetically Modified Organisms (GMO’s)?
3. Was there a perceptible difference in taste quality between conventionally and organically grown foods?
While the nutrient quality of foods is of great importance, I believe that there are numerous other “confounding” variables that are perhaps equally, if not more relevant, to our long-term health. The reality is that the cumulative effects of the regular consumption of foods that may have measurable amounts of antibiotics, hormones, or pesticide residues are largely unknown, and there is sufficient epidemiologic evidence to reasonably conclude that the effects of these agents may be deleterious to our long-term health. Further, many conventional methods of food production utilize GMO’s – the long term effects of which are also unknown. Thus, prudence demands that we consider the comparison of these critically important factors as well in future studies.
One of the key principles in the study of Epidemiology is always to remain acutely aware of what we have “left out” in a study. The study under discussion successfully met its stated objective of nutrient comparison between organic and conventional foods. However, if we are to use this study’s conclusion as a guideline to long-term health, we must keep in mind the variables that were either: 1) clearly outside of the purview of this particular study, and/or 2) still remain to be examined in future studies.
I wouldn’t consider an occasional (or regular) splurge on organic tomatoes or peaches a waste yet! Notwithstanding some of the important reasons outlined above, the generally accepted superior freshness, taste, and flavor of locally and often sustainably produced organic foods are sufficient reasons for us to enjoy them still.
Resources:
For those who have not yet viewed the PBS Documentary The Silence of the Bees, the potential loss of the majority of fruits and vegetables from our planet by the year 2035 may seem like an absurd, perhaps even an alarmist notion. However, one viewing of this “must see” documentary ought to convince anyone that in this case, there truly is cause for genuine alarm; so much so, that the alarm must drive us all to positive and concrete action - now.
Here – in a nutshell – is the summary of a problem that is unlike one that has ever been faced previously by mankind in history: Starting in the Winter of 2006, millions of bees vanished without a trace from their hives across the United States and Europe, and are still continuing to do so. The disappearance of the honey bees - who are the indispensable pollinators of fruits and vegetables – has left billions of dollars of crops at risk and has threatened our food supply in a manner that has never been experienced before. Given the unprecedented nature of the problem, and the agricultural nightmare that looms ahead with the loss of the vast majority of fruits and vegetables, scientists are now scrambling to understand the causes behind the disappearance of the honey bees - both in the West, as well as in many other parts of the globe.
One of the main causes that has been identified as being responsible for the disappearance of the honey bees is referred to as CCD or Colony Collapse Disorder. It has been confirmed that a virus known as IAPV has been found in all CCD hives. The origin of this virus is in Israel; thus, it remains to be understood how this particular virus made it to the U.S. hives. Other possible causes of the disappearance of the bees are under study as well. These include understanding whether the mass relocation/transportation of bees in the service of Industrialized agriculture, high crop yield, and efficiency of production has contributed to a loss of immunity in the bees, resulting in their premature death.
The problem we are left to face is an enormous one. Scientists featured in the PBS documentary warn that if we are unable to stop the further loss of bees, we are faced with the loss of the very foods (fruits, nuts, and vegetables) that protect us from chronic illnesses. The reality is that there are no known means to pollinate the blossoms of fruit or nut trees that can begin to compare with the efficiency of honey bees. As an example, a hive of bees pollinates 3 million flowers a day; however, when an effort is made to pollinate flowers manually, it has been estimated that one human being can pollinate a maximum of only 3 trees a day. Further, it is estimated that to replace honey bees with human or artificial pollinators would cost about 90 billion dollars a year in the U.S. alone; and even so, such an effort may not be sustainable for long.
The bottom line? It is amply evident that now is the time for us to put in concerted effort and resources into finding a viable solution to this very serious problem, which, if left unchecked, is expected to turn into a global crisis. It is estimated that if the bees continue to disappear at the current rate, the honey bee population in the United States will cease to exist by the year 2035.
What can you do to help the bees, and both our current and future food supply?
1. Become informed about the gravity of the problem – View The Silence of the Bees.
2. Learn how you can help by visiting the PBS Nature Site.
3. Check out the Web and Print Resources designed to create awareness and action steps to address this problem.
4. Support sustainable agricultural practices that have for centuries preserved the health of honey bees.
5. Share this post, related information, and the PBS documentary with concerned others.
Our health, our future, and the future of our food supply rests in our own hands.
The Centers for Disease Control Advisory Committee has issued recommendations on who should receive the vaccine against novel influenza A (H1N1) when it becomes available. The Committee has also provided guidelines with respect to which population groups must be prioritized to receive the vaccine if it is initially available in extremely limited quantities. The guidelines issued recommend that vaccination efforts focus on 5 key populations:
1. Pregnant women
2. People who live with or care for children younger than 6 months of age
3. Health care and emergency services personnel
4. Persons between the ages of 6 months through 24 years of age, and
5. People from ages 25 through 64 years who are at higher risk for novel H1N1 because of chronic health disorders or compromised immune systems.
The population groups outlined above total approximately 159 million people in the U.S. Although a shortage in the supply of the novel H1N1 vaccine is not expected, it is believed that initially the availability of – and demand for – the vaccine may be unpredictable. For this reason, the Committee has provided additional guidelines in the event the vaccine is available in limited quantities, especially initially, and has recommended that in such a case the following groups receive the vaccine before others:
- Pregnant women
- People who live with or care for children younger than 6 months of age
- Health care and emergency services personnel with direct patient contact
- Children 6 months through 4 years of age, and
- Children 5 through 18 years of age who have chronic medical conditions.
It has been further recommended that once the demand for vaccine for the prioritized groups has been met at the local level, providers should begin vaccinating everyone from ages 25 through 64 years.
In light of the above guidelines, the most frequent question seems to be one that expresses concern as to whether the novel H1N1 vaccine is meant to replace the seasonal flu vaccine. The answer to that question is: The novel H1N1 vaccine is not intended to replace the seasonal flu vaccine; rather, it is intended to be used alongside the seasonal flu vaccine. Further, CDC guidelines state that both vaccines may be administered on the same day.
Individuals dealing with specific conditions such as Cardiovascular disease or HIV infection, and groups that may have special needs such as clinicians, child-care providers, etc. should refer to the following key resources for valuable additional information.
Resources/Further Information:
Read the full CDC Press Release
H1N1 Flu – Important information for specific groups
Information on Antiviral drugs; Self and patient care in the event of an H1N1 infection.
100,000 New cases of Swine Flu were reported in England last week — a number that is nearly double that of the count from the seven days prior to last week. The age group that seems to be affected the most is 14 years and younger. The death toll in England from Swine Flu is currently at 26, and 840 patients have been hospitalized. In an effort to prevent the virus from spreading futher, British airlines put measures into effect last week to stop people with Swine Flu from boarding flights.
In light of the rapid spread of the H1N1 virus in England, a great amount of concern seems to be developing here in the U.S. Of greatest concern is the issue of children returing to school during what is considered “peak” flu season. Although anti-viral medications are available, I sense that there is a great deal of panic surrounding the issue of children contracting the virus in the upcoming Fall months. Over the weekend, I received numerous e-mails inquiring about the best way(s) to be prepared to deal with a possible infection.
To answer the above, I would like to refer all readers to the Centers for Disease Control Q & A site: Novel H1N1 Flu and You. This site should answer all your questions authoritatively and equip you well.
Panic is never the answer; but being well-armed with knowledge is. Please stay informed, and pass on the link to all who may benefit.
Trials for the H1N1 vaccine will commence in August this year in the United States. The announcement was made by the University of Maryland, yesterday, July 22.
Due to the fact that the Swine Flu virus has very significant potential to cause illness or hospitalizations, the effort is to have the vaccine tested for safety and effectiveness prior to the flu season — which is officially considered to be in the Fall and Winter. Upcoming clinical trials are expected to enroll 1000 adults and children at 10 centers around the country. Additional trials may also be undertaken to test how the Swine Flu vaccine works in combination with the seasonal flu vaccine.
A couple of tips to all concerned as we approach the Fall season:
1. Like other flu types, H1N1 is thought to be spread mainly from person to person through coughing or sneezing. Simple precautions of covering one’s nose and mouth while coughing/sneezing, and good hygiene (washing hands frequently) are common sense precautions that all should follow.
2. CDC recommends that if you are sick, or suspect you are, you must stay at home to prevent the spread of infection to others.
3. Stay updated regularly with respect to news on this topic. Being informed is on top of the list with this pandemic. The CDC hotline for this subject is 1-800-CDC-INFO.
I am interrupting the WHOLE FOODS series to write briefly on a very important announcement. Many of you may know that the H1N1 virus responsible for the propagation of Swine Flu has been a matter of very significant concern. The World Health Organization (WHO) reported just yesterday that thus far, more than 700 people have died from contracting the virus, and there are now 98,000 documented Swine Flu cases worldwide involving 120 countries. WHO declared H1N1 a global pandemic on June 11, 2009.
The alarm surrounding the Swine Flu crisis is due to the fact that the H1N1 virus has spread around the world with unprecedented speed. WHO has reported that past influenza viruses have needed more than six months to spread as widely as the current H1N1 virus has spread in less than six weeks.
The first human trials of a Swine Flu vaccine are commencing today (Wednesday, 7/22) in Melbourne, Australia. The vaccine for the H1N1 virus will be tested on 240 volunteers. Scientists believe that the H1N1 is a new strain of a tenacious virus that may require a higher and more frequent dosing to generate the desirable immune response in humans.
![usmap27[1]](http://thepreventionrevolution.files.wordpress.com/2009/07/usmap2711.jpg?w=600&h=418 "usmap27[1]")
Let us hope that the results from the vaccine testing are positive. In the meantime, please stay informed and protect yourself by keeping on top of important news on the subject. Stay tuned here for critical updates, or check the following authoritative resources for more information.
H1N1 Flu Situation Update from CDC
Hi Friends — A Prevention Revolution article published on BasilandSpice.com yesterday (July 20, 2009) was featured on Google News’ First Page Top Stories of the Day. I think of this as good news not only because it helps expand readership for this site, but because the dissemination of articles on this site is a means to create and build awareness of how we can really work together to help prevent numerous chronic diseases. My passion is to bring life-saving research to everyday individuals, as well as to physicians, and to that end any and all dissemination is good. My sincere thanks to Kelly Jad’on, Director at Basil And Spice, for hosting the article.
To celebrate, and to kick off our WHOLE FOODS SERIES today, I won’t embellish on research as I usually do. How about we just start off with a fabulous, but simple whole foods breakfast recipe, and in a day or so, we’ll talk about why it’s so good for you.
Getting a delicious and satisfying breakfast can be hard, especially in the rush of the morning, but this simple recipe just might make you put your RTE cereals aside for a long hiatus! And, you can be assured that it will nourish you far better than anything else you can get in the limited time often available for breakfast in the morning. Here it is:
BLUEBERRY PACKED GRANOLA AND YOGURT TREAT
8 oz. Organic Plain Non-Fat Yogurt (Buy a brand that has abundant live cultures)
1/2 -3/4 Cup Frozen Wild or Maine Blueberries
1-2 Tea sp. 100% Pure Maple Syrup
1/4 Tea sp. Pure Vanilla Essence (Optional)
1 Packet Nature Valley (or other very high quality) Oats and Honey Granola Bars (2 bars)
1 Tea sp. crushed flax seeds (Crushed seeds can be purchased and kept in the refrigerator, or you can purchase whole organic flax seeds and crush them at home in a coffee-grinder)
PREPARATION:
1. Let blueberries thaw slightly at room temperature.
2. Next, crush the granola bars coarsely or finely (according to taste/preference). Set aside.
3. In an attractive glass bowl, blend the yogurt with the maple syrup and vanilla till it has a very smooth consistency.
4. Add the crushed granola and the crushed flax seeds to the yogurt mix, and stir in gently.
5. Top with the semi-thawed blueberries (They should be juicy, but slightly crunchy)
6. ENJOY a morning treat that feels like you are eating ice-cream; the difference being that it is packed full of energy, nutrition, and good health!
If you streamline the above recipe (i.e. have all ingredients on hand ahead of time), it should take no more than 5-7 minutes to prepare this delicious treat. Feed it to your kids as well — It beats any pop-tarts or frozen breakfasts you may be giving them in the interest of saving time.
In the next post, I will talk about what it really means to call a food WHOLE, why it matters so very much, and why the recipe you just read can do you good.
Until then, Bon Appétit!
This week, we start a brand new series of very practical posts on using WHOLE FOODS for creating outstanding health. Why do this?
In the West, and in the nations generally perceived to be “Western” (U.S., Most of Europe, Australia/NZ), we find that we are at present faced with a more or less common set of chronic diseases; Heart disease, diabetes, obesity, and certain cancers being the most prominant. Interestingly, we now also find that nations that have relatively recently undergone “Westernization” (economically speaking) such as China, India, Ireland, and others, are faced with…guess what? — Explodingly high rates of the same chronic diseases; Heart disease, diabetes, obesity, and (increasingly) certain cancers again being the most prominant. What is the connection here? What if we could identify and address the factor(s) that have been contributing to high rates of chronic diseases in the West, and now increasingly Globally?
Research suggests that ONE factor that is common in the genesis of numerous chronic diseases is the consumption of processed, refined, and denatured foods. Here is what I see to be the crux of the problem, for those in either the West or in the ”Westernizing” nations:
1. People in the West have historically been unfamiliar with certain whole foods that are powerhouses of nutrition and have uncommon ability to create health; Thus, the common question: What exists past whole wheat flour, please? The answer: A LOT! Whole rye, whole barley, whole millet, whole spelt, whole lentil flour(s), lentil flour flat breads — these are the foods that have traditionally been used down the centuries across the rest of the globe. Sadly, these health-packed foods are alien to most in the West, and are not common to the Western vocabulary.
2. On the other hand, people in the East and in other parts othe world have historically been deeply familiar with the grains and flours I have mentioned above, as well as with a plethora of other health-generating Whole Foods. But, those across the globe who in recent years have adapted to their new “Westernized” lives as a result of rapid Industrialization, have now all but given up these traditional foods. They too are now mass consumers of the “fast-food” culture — burgers, pizzas, and shakes rule the day, along with sedentary, stress-filled lifestyles.
So, let’s get to the point — Why write on Whole Foods?
1. To let the Western audience(s) know and learn about the treasures that exist past Whole Wheat Flour, and how to use them greatly to improve their chances of preventing chronic diseases, AND
2. To urge those around the rest of the world who have already turned their backs on Whole Foods, or are in the process of doing so, to reverse or correct course in order to bypass the many dangers ahead.
The perspective of utilizing Whole Foods for creating health must not be dismissed as one that is overly simplistic. There is overwhelming evidence to lead us to conclude that the majority of “Western” (and now increasingly, Global) diseases are conditions that are primarily related to nutritional, lifestyle, and metabolic causes. And, a very simple, yet potent way both to prevent and improve outcomes for these diseases is to start by consuming Whole Foods. In doing so, we are focusing directly on remediating one of the most key contributing causes of the Western and Global chronic disease epidemic.
….Now, here is the treat you are in for over the coming weeks. Not only will you learn about new Whole Foods, you will also learn about mouth-watering ways to enjoy them. I will share some traditional recipes from around the globe that I have labored over the years both to collect and perfect, and I will share how scientific research ratifies the use of these foods for long term health and wellness.
I will continue to write articles and opinion pieces on other topics as well; However, you can look for posts related to Whole Foods under the Category: Whole Foods Series.
STAY TUNED – You can’t afford not to!
Folks – this is a quick update. I just wanted to make a brief post so that that all may become aware of the FDA recall on two lots of the generic version of the drug DIPRIVAN.
Diprivan is an anaesthetic generally administered only at a health-care facility, and the drug is sometimes administered as a powerful sedative. Recently, forty reports came in from around the country of people reporting high fevers and muscle aches after being injected with the drug. Fortunately, all the affected individuals recovered. According to the Centers for Disease Control, two lots of the generic version of Diprivan, also known as Propofol, were contaminated with an endotoxin, a bacterial contamination that can cause fever, and in a high enough dose can cause shock and death.
The contaminated lots are 31305429B and 31305430B. Teva Pharmaceuticals, the drug manufacturer is initiating a voluntary recall for these lots, and clinicians are being advised to immediately stop using these lots of Teva Pharmaceuticals Propofol.
There also appears to have been a previous history of contamination associated with this drug. Please keep the FDA alert in mind, and make others aware of it as well — The use of this drug is not uncommon.
More later, in the next post!
Resources:
Perhaps nothing is more predictable in my career, as both a research scientist and a speaker, than running into one person after another in my audience who asks me the same – and by now – the most predictable question, “…But, how did a heart attack/diabetes/kidney stones/fill in the blank happen to me? You see, I was always so well, always so strong, always so bulletproof, always so.….AND, I even tried really hard to be well.”
It is ironic, isn’t it? We all desire long-term, lasting health. Why do so few of us achieve it? Look around you – I don’t have to tell you that most people are a lot less healthy and fit than they have the potential to be. And this in spite of the ubiquitous availability of fitness and nutrition “gurus.”
After many years of being a dedicated student of medical/nutritional research, combined with several years of interacting with those “surprised” by disease, I have come to a couple of conclusions that may be of benefit to you on your own path to securing health and well-being:
1. Everyone wants “wellness” and “long-term” health, but very few have a coherent, solid strategy to achieve it. Sure, there is a small percentage of genetically blessed individuals (emphasis on “small”) who seem to be able to break all the rules, and yet live long, healthy lives. But, they are the exception. For most of us, achieving truly sound long-term health and well-being requires both effort AND knowledge.
2. But, many make effort – a LOT of effort – and still fail. Why? Here is the answer to that: Effort, commitment, and even discipline toward achieving any goal are worthless without reference to proper technique. World-class athletes know that; Professional swimmers are “professional” only because they have mastered the correct technique(s), and Weight- lifting champions swear by the same principle. What makes us think that the rules change when it comes to creating our ideal health?
All around me, I see individuals chasing after the latest and greatest diet, consuming the fanciest or most expensive supplements, eating the newest “techno-” protein bar for lunch, and downing all this with the most exotic water money can buy in a bottle. Indeed, keeping up with the efforts of those health-obsessed in our current times is often enough to make one breathless.
But, there is only one problem. You guessed it. It’s one of the proper technique.
It is said that the power of the rear wheel is wasted if the front wheel is not directed toward the proper destination. Achieving lasting health requires of us neither complacency (“I had always been well, so I will always be well), nor a fierce and dogged determination to follow the hottest foods/health trend(s) on the market. As a matter of fact, each of those options is nearly guaranteed to fail. Because each of those options is analogous to having “the front wheel” directed toward the wrong destination.
The proper technique – so to speak – to improve our chances of preventing disease and maximizing our chances for health, is neither elusive, nor is it a mystery. It lies simply in the adoption of sound dietary and living habits that have been established to be trustworthy by a body of solid, corroborative research, and have been further ratified by the weight of time-tested observational evidence. Beware of anyone who tells you otherwise, or seeks to re-invent the laws that govern a state of health or disease.
Is it possible to follow “the proper technique” and still fail, sometimes? Yes, it is – because some factors may always be out of our control to modify. But, if research and real-life evidence tell us anything, it is this – Eating and living sensibly guarantees that you will be a LOT less likely to be “surprised” by disease, and a lot more likely to be blessed with the lasting health you desire.
Stay tuned for more on “The proper technique.”
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Please ignore the above post that had to be made for technical reasons.
As a research scientist who speaks frequently on chronic disease prevention, I find that I am often asked two questions by many in the audience, especially with respect to conditions such as heart disease, diabetes, or certain cancers. These questions, which predictably recur, are as follows:
1. In your considered opinion, does food have anything to do with how or why so many people develop heart disease/ high blood pressure/cancer/diabetes/ (fill in the blank)?
2. Does food have anything to do with the prospects of preventing these conditions?
Now, it seems ironic to me, that even in our present time in which solid epidemiological research has indisputably established the link between diet and health, there are still millions of people out there who are uncertain and tenuous about whether this link is truly real. Due to the fact that this topic is very broad, I am deliberately going to restrict this discussion to a few simple truths for the purpose of this post. Let us momentarily consider some of the facts.
It is no secret that today, the West (especially the United States, most of Europe, and Australia) is mired in an epidemic of obesity, diabetes, heart disease, and several (predominant) cancers. Interestingly, this was not always the case. A careful study of the progression of disease rates in the West reveals that chronic disease rates skyrocketed in the West in close correspondence with the transition from largely agrarian to largely industrialized methods of food production. The mass inundation of the supermarket shelves with processed and packaged foods, especially post World War II (and especially in the U.S.), marked a phenomenal change in people’s eating habits, and with that, a literally phenomenal change in the state of their health as well. Whereas at one time, food was produced by one’s own physical labor and was a source first of sustenance, and then of pleasure; this principle became fully reversed with the advent of commercial and industrialized foods. Now, it became more about pleasure first, and then sustenance (if at all). Refined, over-processed, over-salted, over-sweetened and trans-fat laden foods came to rule the supermarket shelves, and then our taste buds. Even the quality of eggs, meats and dairy suffered, as the goals and objectives of “efficient” corporate mass production took precedence over that of maintaining the purity and nutritive ability of food. This has gone on now for several decades, up to our present time. And now, to all this, we have (albeit unwillingly) added new health destroying variables. Ask most anyone, and they will tell you — Stress and fatigue seem to rule the day; a daily 8 hour shift on the computer occurs with alarming regularity, whereas daily exercise is irregular at best; sleep is elusive and usually averages less than 6 hours a night; the sit-down farm fresh meal, either for lunch or dinner, is a distant pipe-dream of the past, whereas the “techno-protein bar” on-the-go is the dominant reality of the lunch hour, and the home-cooked dinner is a rare treat, hardly the daily norm.
Thus far we have talked about the “West” in general and about nations generally perceived to be Western. Now, let’s take a look at the state of health in nations that have relatively recently undergone Westernization in terms of their socio-economic structure. Two particular and especially salient examples in this category are China and India, and each of these two nations has in recent years seen a truly astronomic rise in rates of obesity, diabetes and heart disease. Interestingly, the rise in chronic disease rates in both China and India (especially in the metropolitan areas) corresponds exactly with their large-scale abandonment of traditional, sustainably produced whole foods, and their adoption of Western-style mass produced processed foods. For example, it is no longer “trendy” in India to make lentils and brown rice with a side of fresh, local vegetables and home-made fresh yogurt for dinner; It is now infinitely more exciting to order “Western” foods for the lunch or dinner meal — hot dogs, burgers, pizza and the like. How do I know? I have been there. These are the new foods there; these are the new items of excitement.
But, the excitement won’t last…and neither should it. The World Health Organization recently estimated that by 2010, 60% – or more than half – of the world’s cardiac patients will be from the Indian subcontinent alone, giving India the dubious distinction of being the country with the highest rate of heart disease in the world. It is interesting, isn’t it, to note that this was once a nation with some of the longest-lived people on the planet? The same was also true for China, for Okinawa…and the list goes on.
It is said that those who refuse to learn the bitter lessons of history are doomed to endure repeating them. And, the lessons of history in this case are simply these: Locally produced, traditional whole foods (whole grains, freshly picked vegetables, fresh fruits, fresh eggs and meats, pure pressed nut and seed oils and other similar foods) both nourish and sustain people, and have done so for centuries. In addition, sustainable agriculture preserves the health of the soil, which in turn literally gives life to the food and thus to people, and often a sense of community as well. But, wherever and whenever people turn their backs on the soil, and chase after the latest and greatest “fast-” or “techno-food” of the day, they chase after a dangerous illusion — one that costs them their vitality and, all too often, even their very lives. And these are the facts, not mere opinion — neither mine nor someone else’s. The numbers establish the truth.
So, does food have anything to do with being sick or staying well? Well, the numbers tell us that the West is sick, and the newly “Westernizing” nations (especially with respect to food and lifestyle) are already sick, and rapidly getting sicker. The food experiments of the U.S., Europe, Australia, China, India, Okinawa, and other nations as well, all testify that those who have no clue where their breakfast, lunch or dinner come from are the sickest of all. Conversely, those who either produce their own food or, at the very least, prepare their own meals from fresh, local foods seem to be beneficiaries of uncommonly long lives and a true joie-de-vivre. Add to this, the fact that substantial research convincingly tells us that with careful attention to the foods we eat and with regular exercise, nearly 70% of certain cancers and 80% of heart attacks are preventable, and the question arises: how much more proof do we really need to believe that what we eat matters?
Let’s sum this up. For those still haunted by whether food really matters, here are the formal answers to the two questions posed at the beginning of this post:
1. Yes, modern denatured, over-processed, commercially prepared, and mass-produced industrialized foods have a lot to do with both how and why so many people develop one or more chronic diseases.
2. Yes, locally and sustainably produced, un-tampered, whole foods have a lot to do with our prospects of preventing these conditions.
While food is not the only factor in the genesis of disease and other factors such as genetic or environmental exposures may play a role in both the genesis of disease or the prevention of it, nonetheless both time-tested and epidemiological evidence bear out that what we eat and how we produce what we eat are fundamental to our well-being and to our very existence.
You see, in any land where nearly every meal is processed, preserved, pre-packaged, frozen, or microwavable; where a myriad of foods are specifically designed to be eaten on-the-go; and where the average adult has neither seen nor can even recognize a kernel of real wheat, rye or barley — health seldom reigns.
Not Just Cookie Dough, Now Beef Too: Massive Recall of Beef Products due to Suspected E.coli Contamination
This is just a quick post, as everyone must know about this. While the puzzle is yet unsolved with respect to how E. Coli bacteria found their way into Nestle’s cookie dough, another disturbing USDA news release this past week announced a massive recall of beef products due to possible E. coli O157:H7 contamination.
On June 24, Colorado firm, JBS Swift Beef Company recalled approximately 41, 280 pounds of beef products that may have been contaminated with E. coli O157:H7. It now appears that the recall has been expanded to 380,000 pounds of beef products following illness outbreaks linked to beef consumption in multiple states. These beef products were shipped to distributors and retail establishments in Arizona, California, Colorado, Florida, Illinois, Michigan, Minnesota, Nebraska, Oregon, South Carolina, Tennessee, Utah and Wisconsin. For a full list of recalled beef products, click on the link at the bottom of this post.
Due to the fact that contamination caused by E. coli O157:H7 can be potentially deadly, the recall has been listed as Class I, or one that translates to high health risk. Even if you do not live in one of the states mentioned above, you may want to review guidelines for safe beef consumption (link below).
Anyway you look at it — whether its dinner (beef) or dessert (cookies) — its quite obvious that our current times require us to be much more alert than usual with respect to keeping on top of the news of the day. Our health and our lives depend on it – literally.
Resources:
Beef Recall June 24 News Release, Recall List, and Beef Safe Consumption Guidelines:
http://www.fsis.usda.gov/News_&_Events/Recall_034_2009_Release/index.asp
In recent times, we have had food scares with infected spinach, peanut butter, even pistachio nuts. But, no one expected a serious problem with good old all- American cookie dough!
Some of you may have been following the multi-state outbreak of E. coli O157:H7 infections that have recently been linked to the eating of Nestles’ raw refrigerated pre-packaged cookie dough. Here is the tally thus far: As of Monday, June 22, 2009, 70 persons have been confirmed to be infected with a strain of E. coli O157:H7. (See map below for states where infected cases have been confirmed). Of these, 30 persons have been hospitalized, and 7 have been confirmed to have developed Hemolytic Uremic Syndrome (HUS). Although most people usually recover from an E. coli O157:H7 infection, about 5-10% go on to develop HUS, which is a severe, life-threatening complication of an E. coli O157:H7 bacterial infection.
For now, it remains a somewhat bewildering mystery as to how a deadly E.coli strain found its way into cookie dough (This strain is usually transmitted through the faeces of certain animals). Given the size of the outbreak, it seems unlikely that the bacteria were transmitted to the product by the unclean hands of an ill plant worker or two. It appears more likely that the transmission may have occurred via infected flour, milk, eggs, or other ingredient(s) in the dough. However, contaminated milk or eggs are usually associated with Salmonella, not E. coli poisoning; thus, a lot of questions remain unanswered with respect to this issue.
Here are some cautions for those of you who may have eaten some raw cookie dough this past week, or had plans to make some Nestle’s cookies this week:
1. Do not eat any varieties of prepackaged Nestle Toll House refrigerated cookie dough due to the risk of contamination with E. coli O157:H7. If you have any prepackaged, refrigerated Nestle Toll House cookie dough products in your home, throw them away.
2. Do not eat cookie dough of any kind, raw! This product is meant to be consumed only after baking. However, at present, it is advisable not to handle the pre-packaged dough even for baking purposes, as handling the infected dough is likely to spread contamination.
3. If you have recently eaten pre-packaged, refrigerated Toll House cookie dough and experienced any symptoms such as vomiting, cramping or diarrhea, contact your doctor immediately.
4. To the best of our knowledge, Nestle’s Toll House Morsels are presently being considered safe for consumption, and the recall does not apply to them.
For more details for those of you who may be dealing with an unfortunate infection, and for those who would like to have more information on this topic, click on the resources provided at the bottom of this post.
As an aside, whatever happened to making cookies the old-fashioned way? It does not take more than a few minutes to mix flour, butter, sugar and eggs — and I don’t believe there is any quality control in the world more rigorous than the one you can exercise yourself! This is another example of how the more removed we get from making and producing food ourselves, the more likely we are to recede from good health as well. The choice is always ours to make.
Resources:
NESTLE’S USA
FULL LIST OF NESTLE’S RECALLED PRODUCTS
http://www.verybestbaking.com/products/tollhouse/product-recall.aspx
CENTERS FOR DISEASE CONTROL, Mortality and Morbidity Weekly Report
http://www.cdc.gov/ecoli/2009/0622.html
Harvard Study Confirms Leaching of Bisphenol-A (BPA) from Polycarbonate Plastic Bottles
Bisphenol-A (BPA) is a chemical commonly used in the manufacture of polycarbonate plastics, and has recently been the subject of profound attention as a result of concern over its effects on human health. The first study of BPA’s effects on humans was published in September 2008 by Iain Lang and colleagues in The Journal of the American Medical Association. In this study, the authors found that high BPA levels were significantly associated with heart disease, diabetes, and abnormally elevated levels of certain liver enzymes1. Research also appears to confirm that BPA exposure during development has carcinogenic effects and produces precursors of breast cancer2, 3.
Human exposure to BPA appears to be associated with the leaching of this chemical from the plastic lining of canned foods and from polycarbonate plastic bottles. Whether ingestion of food or beverages from polycarbonate containers increases BPA concentrations in humans had not been well studied until recently.
A new study published by Harvard researchers in the May 2009 issue of Environmental Health Perspectives confirmed that in their study sample, one week of polycarbonate bottle use increased urinary BPA concentrations by two-thirds4. The study concluded that regular consumption of cold beverages from polycarbonate bottles is associated with a substantial increase in urinary BPA concentrations irrespective of exposure to BPA from other sources.
The full-text manuscript of the Harvard study can be viewed here.
What does this mean for you? In light of results from this latest study, as well as based on results from previous studies, it may be prudent to observe some cautions:
1. All plastic containers are marked with a recycle symbol. Avoid using all food and beverages from containers that have the numbers 3 or 7 listed inside the symbol (unless the plastic indicates that it is BPA-free).
2. Do not heat food/beverages in plastics or expose plastics to hot liquids. Upon heating, BPA leaches out 55 times faster than it does under normal conditions.
3. Epoxy resins containing BPA are used as coatings on the inside of almost all food and beverage cans. Therefore, it is advisable to minimize the use of canned foods.
4. The National Toxicology Panel recommends avoiding microwaving food in plastic containers, putting plastics in the dishwasher, or using harsh detergents, to avoid leaching.
5. STAY ON TOP OF RESEARCH! — This is an evolving field of study, and there may be much more for us to learn. Ignorance often hurts or kills too many. So, stay tuned to this site or keep on top of other authoritative breaking news on this topic.
Notes:
1 Lang IA, Galloway TS, Scarlett A, Henley WE, Depledge M, Wallace RB, Melzer D (2008). Association of Urinary Bisphenol A Concentration With Medical Disorders and Laboratory Abnormalities in Adults. JAMA 300 (300): 1303.
2 Murray TJ, Maffini MV, Ucci AA, Sonnenschein C, Soto AM (2007). Induction of mammary gland ductal hyperplasias and carcinoma in situ following fetal bisphenol A exposure. Reprod. Toxicol. 23 (3): 383–90.
3 Soto AM, Vandenberg LN, Maffini MV, Sonnenschein C (2008). Does breast cancer start in the womb? Basic Clin. Pharmacol. Toxicol. 102 (2): 125–33. Abstract available at: http://www.ncbi.nlm.nih.gov/pubmed/18226065
4 Carwile et al (2009). Use of Polycarbonate Bottles and Urinary Bisphenol A Concentrations. Environ Health Perspect doi:10.1289/ehp.0900604. Full-text available online at: http://www.ehponline.org/members/2009/0900604/0900604.pdf
Food, Inc.,The Movie Comes To Market — It’s Your Time to Vote with What You Choose to Eat
Robert Kenner’s much awaited movie, Food, Inc. hit the market last week on June 12, and has garnered tremendous attention. The movie is designed to be an exposé of the U.S. food industry. In a nutshell, its view is that a handful of mega corporations in the U.S. are putting profits ahead of consumer health. You will see interviews with well known authors and journalists, Eric Schlosser (Author, Fast Food Nation) and Michael Pollan (Author, In Defense of Food: An Eater’s Manifesto).
Here is a link to the film’s trailer: http://www.foodincmovie.com/trailer-and-photos.php
Here is one about the film: http://www.foodincmovie.com/about-the-film.php.
Feel free to write me back with your comments or thoughts on the movie, if any.
Here is my one thought on why this movie is important: We are deluged with chronic diseases in the United States, and I believe that some of the most difficult questions of our time (such as, Why are we sick?) cannot be answered without considering the food we eat and the way we produce it. From that perspective, this movie sheds light on an issue that is crucially important for all of us.
This is a must see documentary, and one that might just make you want to think twice before deciding on what to eat for your next meal! And, I might add that the majority of us need to do just that.
It’s time to cast your vote with how and what you choose to eat.
Tradition and history almost always have important lessons to teach us, and if we are willing to listen, we might just notice that they have a quiet, yet clear and distinct voice. But, neither Tradition nor history force themselves upon us. Once they have been forgotten or lost, they often have to be discovered, or even re-discovered, although they have always patiently been there. Conversely, modern innovations and innovators are usually noisy, loud and aggressive; bursting upon our senses (our very eyes, ears, minds and hearts); demanding our immediate and utmost attention, and often, even our loyalties.
Now, history is not always good, and Modernity is not always bad. But, there is at least one instance in which I can unreservedly say that history and Tradition were good for us, whereas Modernity has been bad — And, this instance applies to the food we eat.
Today, those who live in America and in the Westernized nations around the globe are sick with an endlessly long list of chronic diseases. Heart disease, cancer, diabetes, and obesity top the list — but the list goes on and on. It seems to be an odd paradox, doesn’t it? We live in lands replete with technologically advanced Medicine, we appear to have beautifully laid out foods on clean supermarket shelves, and we have more money to spend on food relative to most people in the world. Why then, are we sick?
Ah! Perhaps we are sick because in this case, the literal stampede of Modernity has come home to roost and fully to take its toll. High levels of chronic disease in Westernized nations are the final symptom of an underlying problem. And, the problem is this: Decades of over-consumption of fast, over-processed, and largely Industrialized foods, coupled with our stress-filled, breathless lifestyles have hollowed us out (sometimes, both physically and emotionally) and depleted our ability to resist disease — And, this is one case where nothing short of a return to Tradition will remedy the crisis.
Traditional, un-tampered, locally grown whole foods sustained generation upon generation for millennia. Yet, in the most recent century, food took on a completely novel character. The ubiquitous and attractive ads for juicy hamburgers and fat-laden pizzas victoriously erased our memories of simple, but nourishing home-made meals; factory-produced and “techno-foods” even appeared insidiously to alter our taste-buds to such an extent that we actually desired to eat them. And, this went on, and on. Fast forward to today, and we find that modern, refined/processed and Industrialized foods have triumphantly all but drowned our connection to the past — and with it, our memory of the way we once used to eat and live.
But, enough. The price we have paid for Modernity in this instance has been too heavy, and our losses, too high, even inestimable. It’s time to turn off the blaring noise of Modernity, and to bring back into our lives some of the riches of Tradition. Loud commercials will continue ad nauseum to entice us to eat the very foods that have nearly destroyed us — it is up to us to turn them off. And, it’s time to re-discover and get re-acquainted with pure, life-giving and life-sustaining whole foods — to taste them again, and remember what we have missed. What we have missed is our health, our sustenance, and in essence, our very well-being which derives life and nourishment directly from the purity and quality of the foods we eat.
Make no mistake — choosing between Tradition and Modernity in this case is not a matter of mere taste or preference. If that were so, I would not have bothered to write this article. But, the matter is much more serious — It is about choosing between health and sickness; in fact, between life and death itself.
If you are reading this, there is still time… and the power to choose resides with you. Use it well.
Among the many common questions that I have been asked by individuals dealing with chronic diseases, I find it interesting to note that there is one question that never seems to go away, and that is: In your considered, professional opinion, which approach do you think is best for my high blood pressure/cancer/elevated cholesterol/(fill in the disease)….Conventional Medicine or Alternative Medicine? Implied in this question is an unspoken presumption, and often a disguised desperate plea for help with what is for many a most difficult decision. The unspoken but clearly implied presumption is that there is something not quite wholly satisfactory about either choice, and that a decision has to be made between two alternatives that seem to be mutually exclusive. In other words, the concerned individual is often resolutely of the opinion that a decision has to be made which is of the either/or type — either “Conventional Medicine” or “Alternative Medicine.” And, I might add that sometimes a physician may have led a patient to believe, either intentionally or otherwise, that he or she must make a decision in favor of one or the other, but definitely not both.
For those experiencing difficulty in working their way out of this perceived conundrum, here are a couple of thoughts that may be helpful: First, it is of critical importance to define exactly what the terms under discussion mean to you. While we may all have a general consensus on the meaning of “Conventional Medicine” (traditional Allopathic medicine), the same is not true for the meaning of “Alternative Medicine.” This latter term often has different connotations for different individuals; thus, it is of great value to establish a level of consensus with respect to its meaning. Technically speaking, the term “Alternative Medicine” refers to therapies that are used in place of Conventional Medicine. However, I find that most individuals using the term “Alternative Medicine” are almost always referring to some kind of nutritional therapy, which they perceive as being outside of Conventional Medicine or even alien to it. Thus, for the purpose of this article only, I am going to speak from the perspective of “Alternative Medicine” as referring specifically to nutrition-based therapies. I am going to speak from this perspective because of all the “alternative” therapies out there, the research-based nutritional approach is perhaps the most thoroughly documented “alternative,” and thus this approach is much more than mere opinion, ‘considered’ or otherwise. Second, I believe that to view Conventional Medicine and another means to wellness (such as research-based nutritional therapies) as a strict either/or choice is to make a gross error. Let me explain this further.
The reality is that when dealing with chronic diseases, the reason why most individuals find either choice (whether conventional or nutritional therapy) somewhat dissatisfactory is because limitations often exist with respect to the scope and benefit of each, depending upon the extent to which disease is already present or has already progressed. For example, if you are already ill, while you may be inclined to exhaust nutritional options for addressing many common health conditions prior to resigning to the lifelong use of drugs or possible surgery, you must also be cognizant of the fact that there are many conditions that indispensably require conventional treatment(s), and especially so if disease has progressed to the point where immediate, acute intervention is required (for example: we all know that at the time of an acute crisis such as a heart attack, it is indispensable to obtain conventional treatment).
In light of the foregoing, I feel that it is extremely crucial to maintain a very rational and objective perspective when it comes to decisions pertaining to choice of therapy. As a research scientist, I am acutely aware of some of Conventional Medicine’s serious limitations, but that does not lead me (neither should it) to indiscriminately shun it. On the contrary, I believe that wisdom lies in keenly understanding both Conventional Medicine’s strengths and limitations and then, using balanced and intelligent discernment when choosing a therapeutic path or paths. Both preventive (largely, nutrition-based) and pharmaceutical (drug-/surgery-based) treatments should be looked at carefully, in a sane, reasonable manner with full cognizance of the overall health and immediate as well as long-term needs of a particular individual. The important point here is that both experiential evidence and research indicate that the more nutrition-based “prevention” we do early, the less drug-/surgery-based “treatments” we generally have to rely on later. But, if and when treatment does become necessary, a couple of critical observations deserve mention. I find that individuals seeking nutritional or other alternative treatments outside of mainstream Conventional Medicine oftentimes tend to develop an irrational hatred, almost a rejection, of any conventional therapy. Similarly, conventional doctors often seem to summarily reject preventive or nutritional approaches, either as legitimate ways to treat the problem, or even as adjuncts to conventional treatments for diseases such as certain cancers, diabetes or even non-life threatening conditions such as moderately elevated blood pressure. In doing so, they make the error of overlooking a solid body of research that unequivocally validates the role of nutrition in not only effectively preventing some of these diseases, but also in improving outcomes for these diseases.
My experience in being a committed student of medical and nutritional research for many years, as well my close contact with treatment outcomes experienced by both traditional doctors and patients, has led me to conclude that each of the previous two approaches is shortsighted and fails to acknowledge and benefit from the possibilities for creating health that are inherent in using both nutrition and pharmaceuticals (each, as needed, and when needed) judiciously. While in recent times, terms such as “Integrative/Alternative Medicine” and “Holistic Medicine” appear to be all around us, the critical thing to remember (whether you are a lay individual or a physician) is that chosen therapies should be evidence-based, that is, they should be therapies that have been tested and corroborated via solid, scientific and epidemiologic research; and further validated through the weight of time-tested observational evidence – such therapies can include both conventional and scientifically researched nutritional therapies. Furthermore, it should be noted that there can be significant advantages in availing of the precision and testing available in Conventional Medicine and utilizing such knowledge for tailoring effective nutritional therapies, or combinations of nutritional and conventional therapies that can augment and bolster each other in the battle against a chronic illness.
Medicine is a thinking person’s business. While we all have our own biases, I believe that this is one realm where reason must decidedly rise above emotion. There is profound evidence for the benefit of validated nutritional therapies for the prevention and amelioration of certain chronic diseases. There is also profound evidence for the benefit of utilizing conventional treatments, especially when disease has progressed significantly. Continuing to view Conventional Medicine and nutritional therapies as either/or options is to our detriment. A wise individual will use both preventive means (soundly proven nutritional therapies) and Conventional Medicine to his or her advantage with a keen awareness of one’s current state of health or extent of illness. Analogously, a good physician will use all valid tools in his or her toolkit; weigh them in light of experience and evidence; and exercise good judgment, discernment and compassion in applying appropriate conventional and/or nutritional therapies with a singular view to serve the specific needs and requirements of a particular individual in the best manner possible.
– This is not a matter of choosing between Conventional or Alternative Medicine. It is…dare I say (?)…the definition of GOOD Medicine.
If you have been surprised, or even shocked, by the announcement of a chronic disease diagnosis, you are astutely aware of what it means to be in “Reaction” mode. If a diagnosis, such as one of diabetes or that of a certain cancer has turned your world upside down because you could never have imagined that such a disease might happen to you – you are also in Reaction mode. “Reaction” simply means that because you had been well for most of your life, you subconsciously presumed that you would always be well – for the rest of your life. Thus, you had no pro-active plan in place to do all you may have done consciously to prevent the disease you have now been diagnosed with. This is not intended as a guilt-trip, but only as a statement of fact. Neither do you presently have such a plan to prevent any disease(s) that may occur in the future. Further, even if you did want to adopt a pro-active plan to prevent as many future diseases as possible, would you be sure as to whom you could authoritatively turn to for help with such a plan? If this describes your predicament, relax…you have company. Those who have experienced “Reaction” constitute 90% or more of those who receive a first-time chronic disease or other life-threatening diagnosis. As a matter of fact, I have lost track of the number of individuals who have shared with me thoughts to the effect of, “I never could have imagined I would have a heart attack at age 39…” and so on.
A second category of individuals is that of those who are certainly not oblivious or “asleep at the wheel” with respect to their journey on the road to health. Rather, these individuals are practicing prevention from the perspective of “catching their disease early,” when it in fact occurs. In medical terms, this translates to “early detection” – whether this applies to detecting diabetes, cancer, heart disease, or another condition. Individuals in this group are generally health conscious. They usually undergo an annual physical and other screening tests, and may even have purchased one or more health/diet book(s) in an effort to educate themselves about health and wellness. They do what they think is best for their health more or less on their own, but often feel that they don’t have a rock-solid assurance that the health-related choices they are making are authoritatively correct. These individuals are “doing prevention” in the sense in which prevention is commonly understood, or following what may be called, “The Current Idea of Prevention.”
Regrettably, “The Current Idea of Prevention” has many failings. While it may be argued that there are certainly undeniable benefits to catching and treating a disease early, two profound problems remain with this approach:
1. If you do indeed “detect” a disease, it clearly means that the disease has already occurred. Research suggests that a disturbed biochemistry always precedes an observed pathology. In simple language, this means that a window of time almost always exists in which disease builds in the body prior to the moment it becomes overtly manifest. Thus, when we wait to “detect” or “catch a disease early,” we inadvertently lose the window of time in which we may have pro-actively and systematically utilized strategies to improve our chances of preventing the disease from occurring in the first place. Sadly, “doing prevention” on your own, even with the help of a good book or two, does not constitute a solid and objective disease prevention strategy.
2. Generally, the “post-detection” period involves a resignation to lifelong dependence on maintenance drugs, especially for conditions such as diabetes, heart disease, and many others. This is because by the time an individual is diagnosed with an acute disease or crisis, the underlying condition has usually progressed to the point where pharmaceutical/other medical intervention becomes obligatory.
While following the strategy of “early detection” (coupled with doing your best on your own with a health book or two) is superior to the “Reaction” non-strategy, I propose that it is time, indeed past time, that we considered another strategy, one that I call, “True Prevention.”
The concept of True Prevention is one that is radically different from the commonly understood idea of “prevention.” This is not a matter of mere semantics. Here is why: I believe that True Prevention is prevention that can and should occur long before the possibility of disease detection. This is prevention that involves a deliberate, systematic and conscious evaluation of one’s eating and living habits and their correction, as needed, in line with recommendations that take into account factors unique to one’s specific needs and that are based on a body of solid evidence-based science rather than on guess-work. This is an approach that involves early nutritional and lifestyle interventions for pro-actively and deliberately doing all you can to prevent disease from occurring in the first place. Ideally, this means that as early as possible in the course of your life, you start building the foundation for good health both for yourself and for your children (if this applies) consciously. In order to undertake prevention of the nature I am describing, you would need to be under the guidance of one or more qualified health professionals, ideally a physician who is sympathetic to such an approach and a nutritional epidemiologist or a competent certified nutritionist. Furthermore, prevention of this kind does not dispense with “early detection.” Rather, it maintains that a systematically planned strategy for chronic disease prevention combined with early detection is better than early detection alone.
True Prevention is thus prevention in its most full-orbed, all encompassing sense. It is the full measure and scope of what prevention should be, and involves a systematic, fully-invested approach to prevention — relative to which, the hap-hazard efforts most of us make to achieve lasting health on our own are often a far cry. Notwithstanding our well-intentioned efforts, the reality is that even the best of us can benefit from professional guidance when it comes to learning how to reliably prevent certain chronic diseases.
But, the question remains — Can we really prevent heart disease, diabetes, certain cancers, and other common chronic diseases, even with True Prevention? If so, to what extent can we do so? The answer to that question is this: The weight of scientific evidence that has emerged especially in the last two to three decades from academic centers globally has convincingly and unequivocally established the potent link between nutritional/behavioral choices and good health. Given this evidence, it would be folly, in fact, even fatal for us to ignore what True Prevention-based efforts can do for us. Dr. Walter Willett, Professor of Nutrition at The Harvard School of Public Health recently stated, “With careful attention to the foods we eat, combined with not smoking and regular physical activity, we find that over 80% of heart attacks and greater than 70% of certain cancers can be avoided.1” So, while we may not be able to wipe out all of cancer with the strategy of True Prevention, we ought to wipe out the 70% of cancer that we can, and so also obviate the 80% of heart attacks that are preventable.
True Prevention will not guarantee that disease will never occur. But, it will help you maximize your chances for preventing chronic disease to the extent it is possible to do so with the power of soundly proven, evidence-based choices. By utilizing this strategy, we do not presume that disease is inevitable. Rather, in light of a rational overview of research-based data and real-life experience, we proceed with the understanding that the majority of common chronic diseases are in fact preventable. And, preventing disease to the maximum extent possible is all that any of us can reasonably ask for.
In the final analysis, the over-arching objective of the strategy I am presenting here is not merely disease prevention. Rather, its larger purpose is to help you envision and real-ize (that is “make real”) an uncommon, even exhilarating level of health and well-being, the innate potential for which – though available to all – lies untapped, undeveloped and dormant for most. It is simply not possible to achieve an outstanding, even exhilarating level of lifelong wellness with only a half-hearted effort. The attainment of health and wellness of this nature is possible only with our full, whole-hearted investment in creating the health we desire, to which end True Prevention is perhaps the most bankable means.
Now, ready for the coup de grâce? What I am asking of us all is ultimately not a matter of making an optional choice. We dare not bestow upon ourselves the luxury of such a delusion. For, if we choose not to make a choice for True Prevention, a choice is made for us by default. The reality is that ALL remaining choices simply do not involve doing all that is possible to do to truly prevent disease. Thus, if we choose not to choose True Prevention, we are, sooner or later (and generally, sooner rather than later) doomed back to Reaction. You see, in this decision, there is not one of us that is permitted to “opt-out” or “get away” without casting a vote.
The choice is ineluctable. The choices are before us. What will be yours?
Notes
1 Third Annual Great Issues in Medicine and Global Health Symposium, 2006. Linking our Food Choices to Cancer Risk, Dartmouth Hitchcock Medical Center.
